Healthcare Provider Details

I. General information

NPI: 1902453152
Provider Name (Legal Business Name): MILLICENT D CROWDER PT. DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 N STATE ST
GREENFIELD IN
46140-1066
US

IV. Provider business mailing address

600 OAKMONT LN STE 600C
WESTMONT IL
60559-5548
US

V. Phone/Fax

Practice location:
  • Phone: 317-467-5700
  • Fax: 317-467-5701
Mailing address:
  • Phone: 630-575-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013539A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: