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NPI Code Detail

MEDICARE: DR. CRYSTAL AMBER HAAKENSON DPT

MEDICARE: DR. CRYSTAL AMBER HAAKENSON DPT
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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1942597968
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRYSTAL AMBER HAAKENSON DPT
Provider Business Mailing Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2011
Last Update Date : 09/02/2021

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