Healthcare Provider Details

I. General information

NPI: 1780068130
Provider Name (Legal Business Name): BRITTANY REID CROSBY LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 MCCORMICK HL
NORMAL IL
61790-5120
US

IV. Provider business mailing address

385 LIMESTONE RD
CHAPIN SC
29036-8605
US

V. Phone/Fax

Practice location:
  • Phone: 309-438-8661
  • Fax: 309-438-5559
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.003771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: