Healthcare Provider Details

I. General information

NPI: 1649924911
Provider Name (Legal Business Name): DYLAN REID CROWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 JENNIFER RD STE A
ANNAPOLIS MD
21401-3367
US

IV. Provider business mailing address

7817 LAKE SHORE DR
OWINGS MD
20736-3140
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24478
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28846
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: