Provider Demographics
NPI:1669490058
Name:CRICKMORE, RENEE J (MPT)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:J
Last Name:CRICKMORE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:RENEE
Other - Middle Name:J
Other - Last Name:LEONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:2105 ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1379
Mailing Address - Country:US
Mailing Address - Phone:610-792-4651
Mailing Address - Fax:610-565-3773
Practice Address - Street 1:528 KIMBERTON RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4737
Practice Address - Country:US
Practice Address - Phone:610-933-6232
Practice Address - Fax:610-933-6234
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALE1765902OtherHIGHMARK
PA099603UUXMedicare ID - Type Unspecified