Basic Information
| Provider Information | |||||||||
| NPI: | 1770533754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSBY | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | ANNA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT/CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 QUARRY LAKE DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212093746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103778900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2700 QUARRY LAKE DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212093746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103778900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X | PT006448L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 2251H1200X | 27378 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | P00097271 | 01 | PA | RR MED IND PROVIDER # | OTHER | 580135 | 01 | PA | BS IND PROVIDER # | OTHER | 0751472000 | 01 | PA | IBC IND PROVIDER # | OTHER |