MEDICARE: DEWEY W CROW PT

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	174400000X	Specialist	PT409	AR

General Provider Information

NPI Number	:	1548281892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEWEY W CROW PT

Provider Business Mailing Address
First Line	:	389 LAKE HAMILTON DR
Second Line	:	A7
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6899
Country	:	US
Telephone Number	:	501-620-9812
Fax Number	:	501-545-4891

Provider Business Practice Location Address
First Line	:	389 LAKE HAMILTON DR
Second Line	:	A7
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6899
Country	:	US
Telephone Number	:	501-620-9812
Fax Number	:	501-545-4891

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	04/07/2014

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