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NPI Code Detail

MEDICARE: MR. GAIL A CRUTCHER MA,PT

MEDICARE: MR. GAIL A CRUTCHER MA,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
1225100000XPhysical Therapist070-002755IL
22251E1200XErgonomics Physical Therapist99129IL

General Provider Information

NPI Number : 1780654129
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GAIL A CRUTCHER MA,PT
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-6200
Fax Number : 630-928-5040
Provider Business Practice Location Address
First Line : 1783 N RICHMOND RD
Second Line :
City : MCHENRY
State : IL
Zip : 60051-5413
Country : US
Telephone Number : 815-385-0730
Fax Number : 815-385-0572
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 06/21/2016

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