Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 08490 | OR |
NPI | 1003156316 |
---|---|
Provider Name | Grace Crumrine |
First Address | Junction City, OR 97448-9449 |
Second Address | Port Orange, FL 32128-8311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2013 |
Last Update Date | 22/02/2013 |