=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285736041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JED L CROWTON PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 SOUTH MAIN ST
-----------------------------------------------------
City | TOOELE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-843-7466
-----------------------------------------------------
Fax | 435-843-9568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 711185
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-942-3311
-----------------------------------------------------
Fax | 801-942-5955
-----------------------------------------------------
=====================================================
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 | 55334532401
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------