Healthcare Provider Details

I. General information

NPI: 1457939357
Provider Name (Legal Business Name): CROWLEY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N CHESTNUT ST
MINONK IL
61760-1271
US

IV. Provider business mailing address

939 W 6TH ST
MINONK IL
61760-1235
US

V. Phone/Fax

Practice location:
  • Phone: 309-322-9444
  • Fax: 309-210-9045
Mailing address:
  • Phone: 309-533-0528
  • Fax: 309-210-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JONATHON CROWLEY
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: MPT
Phone: 309-322-9444