Individual
MRS. DIANE MARIE CROCKETT
Active
Individual
MRS. DIANE MARIE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT005002
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11508426
CAQH
OH
01
—
OH1171721
OHIO DEPT. OF EDUCATION
OH
Enumeration date
10/16/2006
Last updated
11/06/2019
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