Provider Demographics
NPI:1508479890
Name:HUXTABLE, HEATHER LOUISE (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LOUISE
Last Name:HUXTABLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1902
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-1902
Mailing Address - Country:US
Mailing Address - Phone:406-437-1917
Mailing Address - Fax:
Practice Address - Street 1:701 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3645
Practice Address - Country:US
Practice Address - Phone:406-437-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14955802OtherCAQH