Provider Demographics
NPI:1588648778
Name:CROOK, CURTIS MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:MICHAEL
Last Name:CROOK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:30141 ANTELOPE RD
Practice Address - Street 2:STE. A
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7001
Practice Address - Country:US
Practice Address - Phone:951-723-1866
Practice Address - Fax:951-723-1867
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT275140OtherBLUE SHIELD
CA10946793OtherCAQH PROVIDER ID
CA0PT275140OtherBLUE SHIELD
CAGA124ZMedicare PIN