Healthcare Provider Details

I. General information

NPI: 1356332118
Provider Name (Legal Business Name): DANNITA CROSSFIELD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RIVERSIDE DR
CYNTHIANA KY
41031-3801
US

IV. Provider business mailing address

5027 ATWOOD DR STE 2B
RICHMOND KY
40475-8322
US

V. Phone/Fax

Practice location:
  • Phone: 859-234-2600
  • Fax:
Mailing address:
  • Phone: 859-625-0001
  • Fax: 859-625-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002247
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: