Provider Demographics
NPI:1013980085
Name:CROSSMAN, GREGORY EVANS JR (PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EVANS
Last Name:CROSSMAN
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1130
Mailing Address - Country:US
Mailing Address - Phone:978-710-7204
Mailing Address - Fax:978-710-5764
Practice Address - Street 1:1703 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1130
Practice Address - Country:US
Practice Address - Phone:978-710-7204
Practice Address - Fax:978-710-5764
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68847Medicare ID - Type Unspecified