Provider Demographics
NPI:1932262367
Name:CROSS, DAVID LEE (PT CRC EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:CROSS
Suffix:
Gender:M
Credentials:PT CRC EDD
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Other - First Name:
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Mailing Address - Street 1:8330 NAAB ROAD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1932
Mailing Address - Country:US
Mailing Address - Phone:317-872-1501
Mailing Address - Fax:317-872-1507
Practice Address - Street 1:8330 NAAB ROAD
Practice Address - Street 2:SUITE 311 INDIANAPOLIS REHABILITATION AGENCY
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1932
Practice Address - Country:US
Practice Address - Phone:317-872-1501
Practice Address - Fax:317-872-1507
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001687A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I010338OtherCHAMPUS
351642282OtherOTHER PREFERRED NETWORKS
IN000000188416OtherANTHEM
I010338OtherCHAMPUS