MEDICARE: DERRECK J CREWS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT61044062	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT61044062	OTHER	WA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1427625177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRECK J CREWS DPT

Provider Business Mailing Address
First Line	:	7201 W CLEARWATER AVE STE B101
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-1694
Country	:	US
Telephone Number	:	509-544-0265
Fax Number	:	509-987-1614

Provider Business Practice Location Address
First Line	:	343 WELLSIAN WAY
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-4107
Country	:	US
Telephone Number	:	509-946-9191
Fax Number	:	509-946-8247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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