Healthcare Provider Details

I. General information

NPI: 1740637990
Provider Name (Legal Business Name): THERESA CLARE CROWE LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 JOHN MARSHALL HWY SUITE 203
GAINESVILLE VA
20155-4023
US

IV. Provider business mailing address

14535 JOHN MARSHALL HWY SUITE 203
GAINESVILLE VA
20155-4023
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-0974
  • Fax:
Mailing address:
  • Phone: 703-753-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306602442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: