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General NPI Number Information
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NPI Number | 1356739080
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Entity Type | Individual
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Provider Name | CRAIG CROSSMAN PTA
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Gender | Male
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 705 E 13TH ST
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City | GEORGETOWN
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State | TX
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Zip | 78626
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Country | US
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Telephone | 512-743-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 202 PENNSYLVANIA AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1540
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Country | US
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Telephone |
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2050823
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | A03000
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License Number State | KY
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