Provider Demographics
NPI:1174845275
Name:HURTLE, ANGELA A (LMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:A
Last Name:HURTLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1115
Mailing Address - Country:US
Mailing Address - Phone:631-334-2955
Mailing Address - Fax:
Practice Address - Street 1:1058 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1115
Practice Address - Country:US
Practice Address - Phone:631-334-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY797299-01163WG0600X, 163WM0705X, 163WS0200X
NY016924-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist