Provider Demographics
NPI:1992252167
Name:CROW, MATTHEW (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:CROW
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 1:601 E ERIE ST
Mailing Address - Street 2:UNIT 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6200
Mailing Address - Country:US
Mailing Address - Phone:303-507-7760
Mailing Address - Fax:
Practice Address - Street 1:601 E ERIE ST
Practice Address - Street 2:UNIT 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6200
Practice Address - Country:US
Practice Address - Phone:303-507-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13568-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist