Provider Demographics
NPI:1194949529
Name:CRUMB, WARNER EUGENE (PT)
Entity type:Individual
Prefix:MR
First Name:WARNER
Middle Name:EUGENE
Last Name:CRUMB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16250 RED BANK LANE
Mailing Address - Street 2:
Mailing Address - City:MELFA
Mailing Address - State:VA
Mailing Address - Zip Code:23410
Mailing Address - Country:US
Mailing Address - Phone:757-787-4642
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7759
Practice Address - Fax:410-543-7410
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist