Provider Demographics
NPI:1902572175
Name:CROUCH, MAURICEA (PTA)
Entity Type:Individual
Prefix:MISS
First Name:MAURICEA
Middle Name:
Last Name:CROUCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18581 COUNTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9710
Mailing Address - Country:US
Mailing Address - Phone:567-239-1805
Mailing Address - Fax:
Practice Address - Street 1:18581 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9710
Practice Address - Country:US
Practice Address - Phone:567-239-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013083225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant