Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070.015365 | IL |
NPI | 1003084328 |
---|---|
Provider Name | Nicholas E Crosby |
First Address | Chicago, IL 60610-3175 |
Second Address | Chicago, IL 60610-3175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2008 |
Last Update Date | 27/08/2012 |