Basic Information
| Provider Information | |||||||||
| NPI: | 1558692913 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURBAN | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63 | ||||||||
| Address2: | |||||||||
| City: | BRIDGETON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083020048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564519395 | ||||||||
| FaxNumber: | 8564518615 | ||||||||
| Practice Location | |||||||||
| Address1: | 2417 LA VALLE AVE | ||||||||
| Address2: | |||||||||
| City: | VINELAND | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 083606812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092475483 | ||||||||
| FaxNumber: | 8566967861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2010 | ||||||||
| LastUpdateDate: | 03/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00374400 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | 40QA00374400 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.