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General NPI Number Information
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NPI Number | 1619528767
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Entity Type | Organization
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Legal Business Name | CREW RACING, LLC
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 1305 BOARDMAN CANFIELD RD STE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4034
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Country | US
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Telephone | 330-429-0766
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 BOARDMAN CANFIELD RD STE 2
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-4034
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Country | US
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Telephone | 330-429-0766
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Fax | 844-704-4419
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Authorized Official
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Title or Position | OWNER
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Name | CAITLIN GLENN
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Credential | DPT
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Telephone | 330-429-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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