Provider Demographics
NPI:1710134374
Name:CROWE, TRACY D
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:D
Last Name:CROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61789 CREST CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-2606
Mailing Address - Country:US
Mailing Address - Phone:760-366-5668
Mailing Address - Fax:
Practice Address - Street 1:58967 BUSINESS CENTER DR
Practice Address - Street 2:H
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7308
Practice Address - Country:US
Practice Address - Phone:760-228-9657
Practice Address - Fax:760-369-6758
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner