Provider Demographics
NPI:1689288300
Name:CROTTY, BARBARA A (LMT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:CROTTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-0117
Mailing Address - Country:US
Mailing Address - Phone:336-686-0818
Mailing Address - Fax:
Practice Address - Street 1:2879C ROB SHEPARD DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9299
Practice Address - Country:US
Practice Address - Phone:336-686-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist