Provider Demographics
NPI:1629125844
Name:CROSGROVE, CARLA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:L
Last Name:CROSGROVE
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 1:119 BLUE SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4005
Mailing Address - Country:US
Mailing Address - Phone:740-369-4834
Mailing Address - Fax:
Practice Address - Street 1:698 MORRISON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4419
Practice Address - Country:US
Practice Address - Phone:614-868-1115
Practice Address - Fax:614-863-9338
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT5372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2698344Medicare ID - Type Unspecified
OHCR4093521Medicare ID - Type Unspecified