Healthcare Provider Details

I. General information

NPI: 1801146444
Provider Name (Legal Business Name): JONATHON C CROWLEY MPT, MTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N CHESTNUT ST
MINONK IL
61760-1271
US

IV. Provider business mailing address

502 N CHESTNUT ST
MINONK IL
61760-1271
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070019442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: