Basic Information
| Provider Information | |||||||||
| NPI: | 1639430499 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROSBY | ||||||||
| FirstName: | SHACORRAH | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 746 E AURORA RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | MACEDONIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440562732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309080039 | ||||||||
| FaxNumber: | 3309080211 | ||||||||
| Practice Location | |||||||||
| Address1: | 746 E AURORA RD | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | MACEDONIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440562732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309080039 | ||||||||
| FaxNumber: | 3309080211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT013692 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.