Individual
CORY RUSSELL CRECELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
560 COUNTRY CLUB PKWY, SUITE B, EUGENE, OR 97401-6043
(541) 683-5139
(514) 683-5783
Mailing address
1624 W MAIN ST, JEFFERSON CITY, MO 65109-1243
(314) 583-5553
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6656
OR
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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