Provider Demographics
NPI:1538557715
Name:CROCKETT, CHAD (DPT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:CROCKETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 E CARDELLA ST
Mailing Address - Street 2:
Mailing Address - City:FIREBAUGH
Mailing Address - State:CA
Mailing Address - Zip Code:93622-2519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2145 E CARDELLA ST
Practice Address - Street 2:
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2519
Practice Address - Country:US
Practice Address - Phone:559-696-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist