Provider Demographics
NPI:1285260521
Name:HURTIG, MIRISSA (PTA)
Entity type:Individual
Prefix:
First Name:MIRISSA
Middle Name:
Last Name:HURTIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85610 521ST AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:NE
Mailing Address - Zip Code:68726-5230
Mailing Address - Country:US
Mailing Address - Phone:402-640-9737
Mailing Address - Fax:
Practice Address - Street 1:85610 521ST AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:NE
Practice Address - Zip Code:68726-5230
Practice Address - Country:US
Practice Address - Phone:402-640-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1814225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant