Provider Demographics
NPI:1952389827
Name:HURLBERT, GORDON C III (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:C
Last Name:HURLBERT
Suffix:III
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MOUNT CARMEL AVE
Mailing Address - Street 2:GM-ATH RM 135
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1961
Mailing Address - Country:US
Mailing Address - Phone:203-582-8589
Mailing Address - Fax:203-582-3207
Practice Address - Street 1:275 MOUNT CARMEL AVE
Practice Address - Street 2:GM-ATH RM 135
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1961
Practice Address - Country:US
Practice Address - Phone:203-582-8589
Practice Address - Fax:203-582-3207
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist