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General NPI Number Information
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NPI Number | 1578019741
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Entity Type | Organization
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Legal Business Name | CROCKETT RANCH THERAPY SOLUTIONS
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 11705 N US HIGHWAY 89
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-5327
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Country | US
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Telephone | 928-853-9843
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Fax |
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Provider Business Mailing Address
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Address Line | 11705 N US HIGHWAY 89
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-5327
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Country | US
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Telephone | 928-853-9843
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CATHARINE RUSSELL
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Credential | RN
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Telephone | 928-853-9843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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