1699866699 NPI number — JAROD HEATH CROWLEY ATC, CSCS

Table of content: JAROD HEATH CROWLEY ATC, CSCS (NPI 1699866699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699866699 NPI number — JAROD HEATH CROWLEY ATC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWLEY
Provider First Name:
JAROD
Provider Middle Name:
HEATH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699866699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 N 2ND ST
Provider Second Line Business Mailing Address:
MOTHER TERESA CENTER RM 103
Provider Business Mailing Address City Name:
ATCHISON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66002-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-360-7378
Provider Business Mailing Address Fax Number:
913-360-7650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 N 2ND ST
Provider Second Line Business Practice Location Address:
MOTHER TERESA CENTER RM 103
Provider Business Practice Location Address City Name:
ATCHISON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66002-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-360-7378
Provider Business Practice Location Address Fax Number:
913-360-7650
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  24-00345 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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