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: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

IV. Provider business mailing address

3001 EDWARDS MILL RD STE 200
RALEIGH NC
27612-5243
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-4060
  • Fax: 919-781-5246
Mailing address:
  • Phone: 919-781-4060
  • Fax: 919-781-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28846
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: