Provider Demographics
NPI:1689027120
Name:CROUCH, AARON (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:CROUCH
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W GRANDE BLVD
Mailing Address - Street 2:APT. 812
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0602
Mailing Address - Country:US
Mailing Address - Phone:901-605-9946
Mailing Address - Fax:
Practice Address - Street 1:100 W PERRY ST
Practice Address - Street 2:
Practice Address - City:FRANKSTON
Practice Address - State:TX
Practice Address - Zip Code:75763-2528
Practice Address - Country:US
Practice Address - Phone:903-876-3219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT67272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer