Provider Demographics
NPI:1356981732
Name:URRUTIA, HAROLD (LMT)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:URRUTIA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:SOUTH FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2034
Mailing Address - Country:US
Mailing Address - Phone:516-755-5855
Mailing Address - Fax:
Practice Address - Street 1:2260 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3951
Practice Address - Country:US
Practice Address - Phone:786-695-9107
Practice Address - Fax:347-727-0505
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025606225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist