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General NPI Number Information
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NPI Number | 1558719518
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Entity Type | Individual
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Provider Name | AMBER CROUSON LPTA
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Gender | Female
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 130 GREAT BRIDGE BLVD
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3902
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Country | US
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Telephone | 757-512-6982
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Fax |
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Provider Business Mailing Address
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Address Line | 541 AKRON AVE
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City | CHESAPEAKE
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State | VA
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Zip | 23322-7371
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Country | US
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Telephone | 757-418-1406
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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 | 2306604430
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License Number State | VA
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