Provider Demographics
NPI:1194853903
Name:CROUSE, JERI G (PT)
Entity Type:Individual
Prefix:MRS
First Name:JERI
Middle Name:G
Last Name:CROUSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6065 ROSWELL RD
Mailing Address - Street 2:#220
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-256-5655
Mailing Address - Fax:404-256-1720
Practice Address - Street 1:6065 ROSWELL RD
Practice Address - Street 2:#220
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-256-5655
Practice Address - Fax:404-256-1720
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP99434Medicare UPIN
GA65BBCHGMedicare ID - Type Unspecified