Individual
MR. EDDIE LEE CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1400 SHELBY DR, DYERSBURG, TN 38024-3435
(731) 288-5056
(731) 288-5067
Mailing address
1400 SHELBY DR, DYERSBURG, TN 38024-3435
(731) 288-5056
(731) 288-5067
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0000002313
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510385
—
TN
01
—
4039751
BCBS PROVIDER NUMBER
TN
Enumeration date
07/05/2006
Last updated
12/18/2013
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