Provider Demographics
NPI:1851389068
Name:HURST, LAURAYNE PITTMAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAURAYNE
Middle Name:PITTMAN
Last Name:HURST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LAURIE
Other - Middle Name:PITTMAN
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:319 W LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2420
Mailing Address - Country:US
Mailing Address - Phone:936-569-6776
Mailing Address - Fax:
Practice Address - Street 1:4920 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1254
Practice Address - Country:US
Practice Address - Phone:936-568-3158
Practice Address - Fax:936-568-3271
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist