Provider Demographics
NPI:1639478944
Name:CROUCH, RODNEY WEBB SR (LMT)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:WEBB
Last Name:CROUCH
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LAUREL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2500
Mailing Address - Country:US
Mailing Address - Phone:803-240-8084
Mailing Address - Fax:
Practice Address - Street 1:1400 LAUREL ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2500
Practice Address - Country:US
Practice Address - Phone:803-240-8084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist