Provider Demographics
NPI:1528478930
Name:CROSBY, JIMMY AARON (LMT)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:AARON
Last Name:CROSBY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 BERT KOUNS INDUSTRIAL LOOP #11
Mailing Address - Street 2:STE G
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118
Mailing Address - Country:US
Mailing Address - Phone:318-686-1186
Mailing Address - Fax:318-686-1053
Practice Address - Street 1:5324 CYPRESS ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7694
Practice Address - Country:US
Practice Address - Phone:318-396-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA7163174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist