Provider Demographics
NPI:1245295583
Name:CROWDER, CARRIE LYNN (ATC)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
Last Name:CROWDER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 EDGEHILL DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-2229
Mailing Address - Country:US
Mailing Address - Phone:814-421-6614
Mailing Address - Fax:
Practice Address - Street 1:3528 ROUTE 119 HWY S
Practice Address - Street 2:
Practice Address - City:HOMER CITY
Practice Address - State:PA
Practice Address - Zip Code:15748-1594
Practice Address - Country:US
Practice Address - Phone:724-479-2231
Practice Address - Fax:724-479-2813
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer