Provider Demographics
NPI:1801232830
Name:CROSSMAN, AMBER DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:DAWN
Last Name:CROSSMAN
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 1:814 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-8610
Mailing Address - Country:US
Mailing Address - Phone:406-315-3456
Mailing Address - Fax:
Practice Address - Street 1:908 8TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2165
Practice Address - Country:US
Practice Address - Phone:406-454-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2373225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant