Provider Demographics
NPI:1053476432
Name:CROSBY, CHANDLER S (PT)
Entity Type:Individual
Prefix:MR
First Name:CHANDLER
Middle Name:S
Last Name:CROSBY
Suffix:
Gender:M
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:PO BOX 249
Mailing Address - Street 2:NORTH COAST THERAPY LLC
Mailing Address - City:WADDINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:13694-0249
Mailing Address - Country:US
Mailing Address - Phone:315-388-7703
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:WADDINGTON
Practice Address - State:NY
Practice Address - Zip Code:13694-0249
Practice Address - Country:US
Practice Address - Phone:315-388-7703
Practice Address - Fax:315-388-4707
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0151691225100000X
NY015169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist