Provider Demographics
NPI:1265932065
Name:CROWLEY, NATALIE SUE (ATC, EMT, ROT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUE
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:ATC, EMT, ROT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 DION ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1519
Mailing Address - Country:US
Mailing Address - Phone:802-373-7036
Mailing Address - Fax:
Practice Address - Street 1:133 FAIRFIELD ST STE 101
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1726
Practice Address - Country:US
Practice Address - Phone:802-752-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.0121764207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine