Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1053659862 |
---|---|
Provider Name | Anthony Croxton |
First Address | Greenville, CA 95947-0554 |
Second Address | Greenville, CA 95947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2013 |
Last Update Date | 29/01/2013 |