Provider Demographics
NPI:1184289852
Name:HUTH, CHARLES CHRISTOPHER (PTA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:HUTH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 SE MCMASTER ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6844
Mailing Address - Country:US
Mailing Address - Phone:561-494-4538
Mailing Address - Fax:
Practice Address - Street 1:2242 SE MCMASTER ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6844
Practice Address - Country:US
Practice Address - Phone:561-494-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28406225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant