Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 50019382401 | UT |
NPI | 1003064262 |
---|---|
Provider Name | Dr. Craig M Crookston |
First Address | Salt Lake City, UT 84112-8924 |
Second Address | Salt Lake City, UT 84112-8924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 29/08/2008 |