Diane Marie Crockett, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT005002 Issued in OH

Practice address

11136 Ravenna Rd
Twinsburg, OH 44087-1022

Phone

(330) 486-2000

Fax

(330) 425-7216

NPI assigned

Oct 16, 2006

Last updated

Nov 6, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Therapy in Motion

  • Physical Therapist
  • Medina, OH
  • NPI 1578708871
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1063592806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 ROCKSIDE RD STE 500",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441312178",
            "telephone_number": "216-489-2846",
            "fax_number": "216-901-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11136 RAVENNA RD",
            "city": "TWINSBURG",
            "state": "OH",
            "postal_code": "440871022",
            "telephone_number": "330-486-2000",
            "fax_number": "330-425-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT005002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11508426",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO DEPT. OF EDUCATION",
            "identifier": "OH1171721",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jaclyn A Crissinger, M.S., BCBA
• Christina Lynn Cross
• Lisa Cuffari
• Madison Culp
• Robert Cundiff, PT
• Jonathan Emmanuel Cunningham, AGACNP-BC

• Physical Therapist in Twinsburg, OH
• Providers in Twinsburg, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.