Provider Demographics
NPI:1861868200
Name:CRABTREE, CHAD (PTA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9707 BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9701
Mailing Address - Country:US
Mailing Address - Phone:740-814-3110
Mailing Address - Fax:
Practice Address - Street 1:584 COUNTY LINE RD W
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7245
Practice Address - Country:US
Practice Address - Phone:614-355-6060
Practice Address - Fax:614-355-6070
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA-5588225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant