Provider Demographics
NPI:1710059456
Name:CROWE, DANA LYNNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LYNNE
Last Name:CROWE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:LYNNE
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:17656 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4609
Mailing Address - Country:US
Mailing Address - Phone:714-849-0880
Mailing Address - Fax:
Practice Address - Street 1:2100 MAIN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2475
Practice Address - Country:US
Practice Address - Phone:714-374-0233
Practice Address - Fax:714-374-0244
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3156225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant