Provider Demographics
NPI:1003084328
Name:CROSBY, NICHOLAS E (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
Last Name:CROSBY
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 1:121 W CHESTNUT ST
Mailing Address - Street 2:APARTMENT 1604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3175
Mailing Address - Country:US
Mailing Address - Phone:773-961-5322
Mailing Address - Fax:
Practice Address - Street 1:121 W CHESTNUT ST
Practice Address - Street 2:APARTMENT 1604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3175
Practice Address - Country:US
Practice Address - Phone:773-961-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.015365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist