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General NPI Number Information
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NPI Number | 1013540681
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Entity Type | Individual
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Provider Name | MR. ELLWOOD CHARLES CROUSE III
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Gender | Male
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 215 ALLEGHENY AVENUE #204
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City | OAKMONT
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State | PA
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Zip | 15139-2059
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Country | US
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Telephone | 412-423-5445
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Fax | 724-212-3595
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Provider Business Mailing Address
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Address Line | 113 CLINTON AVE.
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City | LOWER BURRELL
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State | PA
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Zip | 15068-2620
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Country | US
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Telephone | 412-996-9128
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Fax | 724-212-3595
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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