Basic Information
| Provider Information | |||||||||
| NPI: | 1518246693 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURLBUTT | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 LAKE CAROLYN PKWY | ||||||||
| Address2: | APT 564 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750394806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6205155598 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4401 LONG PRAIRIE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750281794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726911331 | ||||||||
| FaxNumber: | 9726911731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2011 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1206605 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.