Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013540681 |
---|---|
Provider Name | Mr. Ellwood Charles Crouse III |
First Address | Lower Burrell, PA 15068-2620 |
Second Address | Oakmont, PA 15139-2059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2020 |
Last Update Date | 21/02/2020 |