Provider Demographics
NPI:1457890287
Name:CROCHET, TATIANA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:
Last Name:CROCHET
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 1:18881 VON KARMAN AVE
Mailing Address - Street 2:SUITE 1240
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1500
Mailing Address - Country:US
Mailing Address - Phone:949-885-0300
Mailing Address - Fax:
Practice Address - Street 1:18881 VON KARMAN AVE
Practice Address - Street 2:SUITE 1240
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1500
Practice Address - Country:US
Practice Address - Phone:949-885-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA48522225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant