Provider Demographics
NPI:1245284678
Name:HURST, KATIE C (MPT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:C
Last Name:HURST
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:C
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:8109 BLUE CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6768
Mailing Address - Country:US
Mailing Address - Phone:702-395-6393
Mailing Address - Fax:
Practice Address - Street 1:2851 N TENAYA WAY
Practice Address - Street 2:STE 205
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0453
Practice Address - Country:US
Practice Address - Phone:702-655-9456
Practice Address - Fax:702-655-9594
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV39594Medicare PIN