Healthcare Provider Details

I. General information

NPI: 1861868200
Provider Name (Legal Business Name): CHAD CRABTREE P.T.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 COUNTY LINE RD W
WESTERVILLE OH
43082-7245
US

IV. Provider business mailing address

9707 BUTLER RD
NEWARK OH
43055-9701
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-6060
  • Fax: 614-355-6070
Mailing address:
  • Phone: 740-814-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-5588
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: