Provider Demographics
NPI:1215030556
Name:MCCRUM, NEAL (MSPT)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:MCCRUM
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1232
Mailing Address - Country:US
Mailing Address - Phone:269-459-6212
Mailing Address - Fax:269-585-6068
Practice Address - Street 1:1908 W MILHAM AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1232
Practice Address - Country:US
Practice Address - Phone:269-459-6212
Practice Address - Fax:269-585-6068
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist