Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 10216 | OH |
N | 2251E1200X | Ergonomics | 10216 | OH |
N | 225XE1200X | Ergonomics | 10216 | OH |
N | 2251G0304X | Physical Therapist - Geriatrics | 10216 | OH |
N | 2251N0400X | Physical Therapist - Neurology | 10216 | OH |
N | 2251S0007X | Physical Therapist - Sports | 10216 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | 10216 | OH |
NPI | 1346457835 |
---|---|
Provider Name | Dr. Dominic Dennis Crock |
First Address | West Lafayette, OH 43845-9602 |
Second Address | Cambridge, OH 43725-8550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |