Provider Demographics
NPI:1013392216
Name:CROUCH, GRACE (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 COMMONS BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3773
Mailing Address - Country:US
Mailing Address - Phone:937-320-9131
Mailing Address - Fax:937-320-9132
Practice Address - Street 1:2655 COMMONS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3773
Practice Address - Country:US
Practice Address - Phone:937-320-9131
Practice Address - Fax:937-320-9132
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.015530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist