Provider Demographics
NPI:1083439764
Name:CROSBY, TONI EVETTE (LMT)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:EVETTE
Last Name:CROSBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:EVETTE
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:605 ATHENS HWY UNIT 1-201
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4770
Mailing Address - Country:US
Mailing Address - Phone:404-538-8019
Mailing Address - Fax:
Practice Address - Street 1:2125 LOGANVILLE HWY STE 202
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1657
Practice Address - Country:US
Practice Address - Phone:404-538-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist