Provider Demographics
NPI:1003912981
Name:HUSELTON, CHRIS ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:ALAN
Last Name:HUSELTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MUSEUM RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4761
Mailing Address - Country:US
Mailing Address - Phone:501-329-3804
Mailing Address - Fax:501-329-0718
Practice Address - Street 1:1500 MUSEUM RD STE 104
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4761
Practice Address - Country:US
Practice Address - Phone:501-329-3804
Practice Address - Fax:501-329-0718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT2073OtherPT LICENSE