Provider Demographics
NPI:1003832114
Name:CROCKETT THERAPY SERVICES
Entity Type:Organization
Organization Name:CROCKETT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD (CHIP)
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-747-2933
Mailing Address - Street 1:407 GOSSETT AVE
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-1507
Mailing Address - Country:US
Mailing Address - Phone:936-545-2044
Mailing Address - Fax:936-546-0021
Practice Address - Street 1:407 GOSSETT AVE
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-1507
Practice Address - Country:US
Practice Address - Phone:936-545-2044
Practice Address - Fax:936-546-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063DSOtherBCBS OF TX PROVIDER #
TX00808WMedicare ID - Type UnspecifiedMEDICARE PROVIDER #