Healthcare Provider Details

I. General information

NPI: 1518685213
Provider Name (Legal Business Name): CARRA ROSE CROUCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ROBINSON ST STE 301
BASALT CO
81621-8472
US

IV. Provider business mailing address

300 WULFSOHN RD APT D309
GLENWOOD SPRINGS CO
81601-9022
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1100
  • Fax:
Mailing address:
  • Phone: 216-470-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0002835
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: