MEDICARE: DAVID M CROWLEY MSPT

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	007761	CT

General Provider Information

NPI Number	:	1417915000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M CROWLEY MSPT

Provider Business Mailing Address
First Line	:	137 GAY HILL RD
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2081
Country	:	US
Telephone Number	:	860-319-7351
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 GAY HILL RD
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2081
Country	:	US
Telephone Number	:	860-319-7351
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/19/2012

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