MEDICARE: CRYSTAL HOWARD CRTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227800000X	Certified Respiratory Therapist	19401465	IL

General Provider Information

NPI Number	:	1467210559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL HOWARD CRTT

Provider Business Mailing Address
First Line	:	15410 UNIVERSITY AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-2729
Country	:	US
Telephone Number	:	773-563-0081
Fax Number	:

Provider Business Practice Location Address
First Line	:	15410 UNIVERSITY AVE
Second Line	:
City	:	DOLTON
State	:	IL
Zip	:	60419-2729
Country	:	US
Telephone Number	:	773-563-0081
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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