Provider Demographics
NPI:1871794081
Name:HUBER, CRYSTAL L (PT)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:L
Last Name:HUBER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 15TH ST NE APT 1
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-2155
Mailing Address - Country:US
Mailing Address - Phone:701-667-9071
Mailing Address - Fax:
Practice Address - Street 1:2004 TWIN CITY DR
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3820
Practice Address - Country:US
Practice Address - Phone:701-667-0745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist