Provider Demographics
NPI:1336434646
Name:CRUM, PATTY (PT)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MILLTOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1246
Mailing Address - Country:US
Mailing Address - Phone:330-262-4449
Mailing Address - Fax:330-262-4449
Practice Address - Street 1:210 E MILLTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1246
Practice Address - Country:US
Practice Address - Phone:330-262-4449
Practice Address - Fax:330-262-4449
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist