Brenda Gail Crutcher, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160003860 Issued in IL

Practice address

12490 N Weldon Rd
Rockford, IL 61102-9640

Phone

(815) 289-6325

NPI assigned

Jun 17, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1184884710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12490 N WELDON RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611029640",
            "telephone_number": "815-289-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12490 N WELDON RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611029640",
            "telephone_number": "815-289-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUTCHER",
        "first_name": "BRENDA",
        "middle_name": "GAIL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-17",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160003860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crusaders Central Clinic Association
• Crusaders Central Clinic Association
• Crusaders Central Clinic Association
• Crusaders Central Clinic Association
• Crusaders Central Clinic Association
• Denise E Crute, M.D.
• Ma Ernestine Gisel Cruz
• Eric Cuasay, MD
• Kerin Cummins, APN
• William Kenneth Cunningham, MD

• Physical Therapy Assistant in Rockford, IL
• Providers in Rockford, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; 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.