Provider Demographics
NPI:1225468580
Name:CROSBY, MARY KATHRYN (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:CROSBY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5742 BERRY PATCH LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4395
Mailing Address - Country:US
Mailing Address - Phone:901-830-9193
Mailing Address - Fax:
Practice Address - Street 1:5742 BERRY PATCH LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4395
Practice Address - Country:US
Practice Address - Phone:901-830-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5530225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant