Healthcare Provider Details

I. General information

NPI: 1245862242
Provider Name (Legal Business Name): CREEYONNA HUFF LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 S 61ST ST
TEMPLE TX
76504-6823
US

IV. Provider business mailing address

305 NE LOOP 820 BUSINESS TOWER 1, SUITE 200
HURST TX
76503
US

V. Phone/Fax

Practice location:
  • Phone: 254-774-9991
  • Fax: 866-341-6725
Mailing address:
  • Phone: 817-292-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2137651
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: