MEDICARE: JENNIFER M CROUSE

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	2251P0200X	Pediatric Physical Therapist	037909	NY
2	2251X0800X	Orthopedic Physical Therapist	037909	NY

General Provider Information

NPI Number	:	1184033367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M CROUSE

Provider Business Mailing Address
First Line	:	549 ROWLAND STREET EXT
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6156
Country	:	US
Telephone Number	:	518-332-8487
Fax Number	:

Provider Business Practice Location Address
First Line	:	549 ROWLAND STREET EXT
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6156
Country	:	US
Telephone Number	:	518-332-8487
Fax Number	:

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

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	08/06/2019

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