Provider Demographics
NPI:1437138112
Name:CROCKER, MAUREEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:CROCKER
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 1:720 MONTCLAIR RD
Mailing Address - Street 2:STE 204
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1964
Mailing Address - Country:US
Mailing Address - Phone:205-591-7246
Mailing Address - Fax:205-591-4420
Practice Address - Street 1:720 MONTCLAIR RD
Practice Address - Street 2:STE 204
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1964
Practice Address - Country:US
Practice Address - Phone:205-591-7246
Practice Address - Fax:205-591-4420
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS66440Medicare UPIN