Provider Demographics
NPI:1497976401
Name:CROTHERS, ALAN B (PT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:CROTHERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 S MILLENIUM WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6439
Mailing Address - Country:US
Mailing Address - Phone:208-884-4647
Mailing Address - Fax:
Practice Address - Street 1:1618 S MILLENIUM WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6439
Practice Address - Country:US
Practice Address - Phone:208-884-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist