Provider Demographics
NPI:1730406380
Name:CRUMP, MICHELLE D (PTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:CRUMP
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 1:21 BRYANNA COVE
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:TN
Mailing Address - Zip Code:38058
Mailing Address - Country:US
Mailing Address - Phone:901-497-4851
Mailing Address - Fax:
Practice Address - Street 1:21 BRYANNA COVE
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:TN
Practice Address - Zip Code:38058
Practice Address - Country:US
Practice Address - Phone:901-497-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN649225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant