Provider Demographics
NPI:1053373019
Name:HUBER, CHRISTOPHER RYAN (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:HUBER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 5TH ST S
Mailing Address - Street 2:#12
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-3462
Mailing Address - Country:US
Mailing Address - Phone:605-695-2089
Mailing Address - Fax:
Practice Address - Street 1:1524 5TH ST S
Practice Address - Street 2:#12
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-3462
Practice Address - Country:US
Practice Address - Phone:605-695-2089
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer