Jed Michael Crots, ATC

Individual provider Active NPI Athletic Trainer · Petersburg, MI

NPI 1043758352 · NPPES record last updated Feb 7, 2017

Key facts

NPI
1043758352
Entity type
Individual (NPI type 1)
Primary specialty
Athletic Trainer 2255A2300X
License
AT1259 (KY)
Practice address
8908 Sylvania Petersburg Rd
Petersburg, MI 49270-9338
Phone
(419) 344-7396
NPI assigned
Feb 7, 2017
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
AT1259KYMDAthletic Trainer

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT1259 KY Yes

Addresses

Primary practice location

8908 Sylvania Petersburg Rd
Petersburg, MI 49270-9338

Mailing address

8908 Sylvania-Petersburg Rd
Petersburg, MI 49270-9338
Phone (419) 344-7396

Other providers in Petersburg, MI

All providers in Petersburg, MI · Athletic Trainer in Michigan

Sources for this page

Verify at the official NPI Registry.