Provider Demographics
NPI:1760720544
Name:CROOM, JOSEPH MICHAEL (PTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:CROOM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 CENTENNIAL PL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0572
Mailing Address - Country:US
Mailing Address - Phone:850-727-5406
Mailing Address - Fax:850-727-5764
Practice Address - Street 1:2648 CENTENNIAL PL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0572
Practice Address - Country:US
Practice Address - Phone:850-727-5406
Practice Address - Fax:850-727-5764
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23765225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant