MEDICARE: TAWNIE CROWE PT, 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
1	225100000X	Physical Therapist	PT32436	FL

General Provider Information

NPI Number	:	1942719935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWNIE CROWE PT, DPT

Provider Business Mailing Address
First Line	:	156 WOODLANDS CREEK DR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-3217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 13TH AVE S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5024
Country	:	US
Telephone Number	:	904-853-5106
Fax Number	:

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

Provider Enumeration Date	:	09/22/2017
Last Update Date	:	09/22/2017

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