Provider Demographics
NPI:1932668514
Name:CROW THERAPY, LLC
Entity Type:Organization
Organization Name:CROW THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:662-207-3849
Mailing Address - Street 1:513 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2213
Mailing Address - Country:US
Mailing Address - Phone:662-207-3849
Mailing Address - Fax:662-207-3849
Practice Address - Street 1:218 N BOLIVAR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2624
Practice Address - Country:US
Practice Address - Phone:662-207-3849
Practice Address - Fax:662-207-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05782376Medicaid