Provider Demographics
NPI:1215282306
Name:CROUSE, TIMOTHY D (DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:CROUSE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8094 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2258
Mailing Address - Country:US
Mailing Address - Phone:330-856-2476
Mailing Address - Fax:234-600-5661
Practice Address - Street 1:8094 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2258
Practice Address - Country:US
Practice Address - Phone:330-856-2476
Practice Address - Fax:234-600-5661
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015026225100000X
PAPT022093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist