Provider Demographics
NPI:1730434812
Name:HURLEY, POONAM BHAKTA (PT, DPT)
Entity type:Individual
Prefix:
First Name:POONAM
Middle Name:BHAKTA
Last Name:HURLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:POONAM
Other - Middle Name:
Other - Last Name:BHAKTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:842 N HIGHLAND AVE NE STE TER
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306
Practice Address - Country:US
Practice Address - Phone:678-685-9356
Practice Address - Fax:678-685-9357
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist