Provider Demographics
NPI:1033532650
Name:CROCKETT, STEVEN THOMAS (P T)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:THOMAS
Last Name:CROCKETT
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W PARK
Mailing Address - Street 2:STE 101
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8336
Mailing Address - Country:US
Mailing Address - Phone:936-327-8080
Mailing Address - Fax:936-327-8086
Practice Address - Street 1:210 W PARK
Practice Address - Street 2:STE 101
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8336
Practice Address - Country:US
Practice Address - Phone:936-327-8080
Practice Address - Fax:936-327-8086
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1161333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist