Provider Demographics
NPI:1669878153
Name:CREST, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:CREST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COMMONWEALTH AVE
Mailing Address - Street 2:124 -SPORTS MEDICINE
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3800
Mailing Address - Country:US
Mailing Address - Phone:617-552-0996
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE
Practice Address - Street 2:124
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3800
Practice Address - Country:US
Practice Address - Phone:617-552-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189-AT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer