Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT23467 | FL |
Y | 2251X0800X | Physical Therapist - Orthopedic | PTL9983 | CO |
NPI | 1033318183 |
---|---|
Provider Name | Bryan Crouch |
First Address | Greenwood Village, CO 80111-2003 |
Second Address | Greenwood Village, CO 80111-2003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 06/06/2008 |