Provider Demographics
NPI:1679053078
Name:CROW, SHERMAN DOUGLAS (PTA)
Entity Type:Individual
Prefix:MR
First Name:SHERMAN
Middle Name:DOUGLAS
Last Name:CROW
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4677 BAYLOR CAMP RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-3199
Mailing Address - Country:US
Mailing Address - Phone:254-424-2185
Mailing Address - Fax:
Practice Address - Street 1:4677 BAYLOR CAMP RD
Practice Address - Street 2:
Practice Address - City:CRAWFORD
Practice Address - State:TX
Practice Address - Zip Code:76638-3199
Practice Address - Country:US
Practice Address - Phone:254-424-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2013306225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant