=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205701513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYMON CROWE DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2025
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24000 HONDA PKWY
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-8612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-645-8777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8614 TOWNSHIP ROAD 125
-----------------------------------------------------
City | KENTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43326-9459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-674-5962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | PT022030
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------