Healthcare Provider Details

I. General information

NPI: 1013347111
Provider Name (Legal Business Name): STACEY CROSBY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S SOUDER AVE
COLUMBUS OH
43222-1539
US

IV. Provider business mailing address

278 CHERRINGTON RD
WESTERVILLE OH
43081-3055
US

V. Phone/Fax

Practice location:
  • Phone: 614-228-5900
  • Fax: 614-228-3989
Mailing address:
  • Phone: 614-746-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7302
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: