Provider Demographics
NPI:1760726434
Name:HUBER, CRYSTAL LOUISE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LOUISE
Last Name:HUBER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LOUISE
Other - Last Name:MACCHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1078
Mailing Address - Country:US
Mailing Address - Phone:203-365-6443
Mailing Address - Fax:
Practice Address - Street 1:1 AUSTON RD STE A
Practice Address - Street 2:
Practice Address - City:EAST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-1385
Practice Address - Country:US
Practice Address - Phone:084-325-7605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9566225100000X
MA20365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist