Provider Demographics
NPI:1053069633
Name:CROWE, HALEY (LMT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:CROWE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BOBBY JONES EXPY STE C
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5253
Mailing Address - Country:US
Mailing Address - Phone:706-860-3355
Mailing Address - Fax:706-860-8765
Practice Address - Street 1:211 BOBBY JONES EXPY STE C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5253
Practice Address - Country:US
Practice Address - Phone:706-860-3355
Practice Address - Fax:706-860-8765
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist