Provider Demographics
NPI:1407973365
Name:CRUTCHER, MELISSA WALWORTH (PT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:WALWORTH
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 TYLER PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6931
Mailing Address - Country:US
Mailing Address - Phone:303-641-8721
Mailing Address - Fax:720-707-1630
Practice Address - Street 1:1239 TYLER PL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-6931
Practice Address - Country:US
Practice Address - Phone:303-641-8721
Practice Address - Fax:720-707-1630
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL 0002611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02782723Medicaid