Healthcare Provider Details

I. General information

NPI: 1609521152
Provider Name (Legal Business Name): CRYSTAL EVELYN HENNINGS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 OAK ST
SEWARD AK
99664-0137
US

IV. Provider business mailing address

PO BOX 696
SEWARD AK
99664-0696
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-2800
  • Fax: 907-224-3798
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number185408
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: