Provider Demographics
NPI:1639430499
Name:CROSBY, SHACORRAH NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:SHACORRAH
Middle Name:NICOLE
Last Name:CROSBY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 E AURORA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2732
Mailing Address - Country:US
Mailing Address - Phone:330-908-0039
Mailing Address - Fax:330-908-0211
Practice Address - Street 1:746 E AURORA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2732
Practice Address - Country:US
Practice Address - Phone:330-908-0039
Practice Address - Fax:330-908-0211
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist