Provider Demographics
NPI:1336870294
Name:CROUCH, HOLLY J (PTA)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:CROUCH
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 1:6465 MILLENNIUM STE 140
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-7831
Mailing Address - Country:US
Mailing Address - Phone:517-975-9900
Mailing Address - Fax:
Practice Address - Street 1:6465 MILLENNIUM
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-6880
Practice Address - Country:US
Practice Address - Phone:517-975-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant