Provider Demographics
NPI:1831558147
Name:CROWLEY, GEORGE JR (PT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:CROWLEY
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLINCY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-9407
Mailing Address - Country:US
Mailing Address - Phone:662-820-6813
Mailing Address - Fax:662-579-3327
Practice Address - Street 1:1365 CLINCY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-9407
Practice Address - Country:US
Practice Address - Phone:662-820-6813
Practice Address - Fax:662-579-3327
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist