Provider Demographics
NPI:1073577409
Name:HILLIARD, CRYSTA YVETTE (PT PHYSICAL THERAPIS)
Entity Type:Individual
Prefix:
First Name:CRYSTA
Middle Name:YVETTE
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:PT PHYSICAL THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 DUNNEGAN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278
Mailing Address - Country:US
Mailing Address - Phone:919-620-6165
Mailing Address - Fax:
Practice Address - Street 1:1600 EAST C STREET
Practice Address - Street 2:MURDOCH CENTER PT OT DEPARTMENT
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509
Practice Address - Country:US
Practice Address - Phone:919-575-1783
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist