Healthcare Provider Details

I. General information

NPI: 1831000264
Provider Name (Legal Business Name): JERRY CROUCH EDD, RRT, RRT-NPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PERRY HILL RD
MONTGOMERY AL
36109-3725
US

IV. Provider business mailing address

1212 TEXAS PKWY
CRESTVIEW FL
32536-2146
US

V. Phone/Fax

Practice location:
  • Phone: 334-272-4670
  • Fax:
Mailing address:
  • Phone: 512-769-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: