Provider Demographics
NPI:1013540681
Name:CROUSE, ELLWOOD CHARLES III
Entity Type:Individual
Prefix:MR
First Name:ELLWOOD
Middle Name:CHARLES
Last Name:CROUSE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CLINTON AVE.
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2620
Mailing Address - Country:US
Mailing Address - Phone:412-996-9128
Mailing Address - Fax:724-212-3595
Practice Address - Street 1:215 ALLEGHENY AVENUE
Practice Address - Street 2:#204
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2059
Practice Address - Country:US
Practice Address - Phone:412-423-5445
Practice Address - Fax:724-212-3595
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist