Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070022330 | IL |
NPI | 1003266412 |
---|---|
Provider Name | Dr. Joseph A Crnich |
First Address | Clarksville, TN 37043-2569 |
Second Address | Fort Campbell, KY 42223-5318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 17/05/2021 |