Individual
MRS. CAROL V CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
521 WEST MAIN STREET, LEBANON, TN 37087
(615) 444-9400
(615) 444-9406
Mailing address
521 WEST MAIN STREET, LEBANON, TN 37087
(615) 444-9400
(615) 444-9406
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
70
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70
TN LICENSE
TN
Enumeration date
08/09/2005
Last updated
01/04/2010
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