Healthcare Provider Details

I. General information

NPI: 1487465217
Provider Name (Legal Business Name): CRUME ATHLETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 CONNOR LN APT 7
MARION AR
72364-5049
US

IV. Provider business mailing address

1104 CONNOR LN APT 7
MARION AR
72364-5049
US

V. Phone/Fax

Practice location:
  • Phone: 870-636-4438
  • Fax:
Mailing address:
  • Phone: 870-636-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIONNA K CRUME
Title or Position: OWNER
Credential:
Phone: 870-636-4438