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General NPI Number Information
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NPI Number | 1669876017
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Entity Type | Individual
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Provider Name | JACOB MCCROWELL DPT, CMTPT
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Gender | Male
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 4554 VIRGINIA BEACH BLVD STE 970
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City | VA BEACH
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State | VA
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Zip | 23462-3047
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Country | US
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Telephone | 757-742-3778
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Fax |
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Provider Business Mailing Address
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Address Line | 2247 W GREAT NECK RD STE 101
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City | VA BEACH
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State | VA
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Zip | 23451-1556
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Country | US
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Telephone | 757-742-3787
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Fax | 757-585-3787
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305206470
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License Number State | VA
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