Provider Demographics
NPI:1740761832
Name:CRUTCHER, LEZLIE ERIN (PTA)
Entity Type:Individual
Prefix:MISS
First Name:LEZLIE
Middle Name:ERIN
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 LEHIGH DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2140
Mailing Address - Country:US
Mailing Address - Phone:209-201-9163
Mailing Address - Fax:
Practice Address - Street 1:797 LEHIGH DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2140
Practice Address - Country:US
Practice Address - Phone:209-201-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9996225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant