MEDICARE: MRS. CRYSTAL L HUBER PT

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	225100000X	Physical Therapist	1447	ND

General Provider Information

NPI Number	:	1871794081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL L HUBER PT

Provider Business Mailing Address
First Line	:	428 15TH ST NE APT 1
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-2155
Country	:	US
Telephone Number	:	701-667-9071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 TWIN CITY DR
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-3820
Country	:	US
Telephone Number	:	701-667-0745
Fax Number	:

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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