Active NPI
Gordon D Husby, PT
- Physical Therapist
- Crystal Lake, IL
National Provider Identifier
1467485128
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070-004524
- Practice address
- 420 N Il Route 31
Crystal Lake, IL 60012-3711 - Phone
- (815) 356-5200
- Fax
- (815) 356-5262
- NPI assigned
- Jul 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-004524 | IL | Primary |
Addresses
Primary practice location
420 N Il Route 31
Crystal Lake, IL 60012-3711
Mailing address
1720 Church St
Johnsburg, IL 60051-8206
Phone (815) 344-5643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-004524 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364083200000",
"number": "1467485128",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1720 CHURCH ST",
"city": "JOHNSBURG",
"state": "IL",
"postal_code": "600518206",
"telephone_number": "815-344-5643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 N IL ROUTE 31",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600123711",
"telephone_number": "815-356-5200",
"fax_number": "815-356-5262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUSBY",
"first_name": "GORDON",
"middle_name": "D",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-08",
"last_updated": "2013-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-004524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.