Basic Information
| Provider Information | |||||||||
| NPI: | 1447917935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURST | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | RENEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | N2032 BONNIE LN | ||||||||
| Address2: | |||||||||
| City: | MARINETTE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541439469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4348258642 | ||||||||
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| Practice Location | |||||||||
| Address1: | FLORENCE HEALTH SERVICES | ||||||||
| Address2: | 5778 CHAPIN ST | ||||||||
| City: | FLORENCE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155284833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501020071 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2305004352 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 15646-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.