Provider Demographics
NPI:1225854409
Name:HURTADO, ALLAN JOSEPH
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:JOSEPH
Last Name:HURTADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 HAVANA DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5676
Mailing Address - Country:US
Mailing Address - Phone:956-231-9783
Mailing Address - Fax:
Practice Address - Street 1:650 9TH AVE SW STE 104
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4502
Practice Address - Country:US
Practice Address - Phone:205-425-5428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11990225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant