Provider Demographics
NPI:1962651372
Name:CROUCH, LAKEESHA (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:LAKEESHA
Middle Name:
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:LAKEESHA
Other - Middle Name:
Other - Last Name:DEARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13850 E 12 MILE RD
Practice Address - Street 2:# 2A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3730
Practice Address - Country:US
Practice Address - Phone:586-445-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist