Provider Demographics
NPI:1013347111
Name:CROSBY, STACEY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:CROSBY
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 1:278 CHERRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3055
Mailing Address - Country:US
Mailing Address - Phone:614-746-6720
Mailing Address - Fax:
Practice Address - Street 1:44 S SOUDER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1539
Practice Address - Country:US
Practice Address - Phone:614-228-5900
Practice Address - Fax:614-228-3989
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7302225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant