=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023494044
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARRIE CROWE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2015
-----------------------------------------------------
Last Update Date | 07/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 E MIDLAND RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48611-9780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-662-7517
-----------------------------------------------------
Fax | 989-662-7516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 E MIDLAND RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48611-9780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-662-7517
-----------------------------------------------------
Fax | 989-662-7516
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501017280
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------