Robert O. Crockett, LPT – Physical Therapist

Key facts

NPI: 1235276809
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: 1015865 (TX)
Practice address: 2230 N Edwards Ave
Mt Pleasant, TX 75455-2036
Phone: (903) 572-8551
Fax: (903) 575-2630
NPI assigned: Jan 31, 2007
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

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

Region 8 Education Service Center Local Education Agency (LEA) · Mt Pleasant, TX · NPI 1265584940

NPD (past)

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1015865	TX	MD	Physical Therapist

Practice roles

Organization	Specialty	Status	New patients
Region 8 Education Service Center		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	1015865	TX	Yes

Addresses

Primary practice location

2230 N Edwards Ave
Mt Pleasant, TX 75455-2036

Mailing address

2230 N Edwards Ave
Mt Pleasant, TX 75455-2036
Phone (903) 572-8551

Other identifiers

Identifier	Type	State	Issuer
126772	Other	TX	CHIP PROVIDER NUMBER

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1235276809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2230 N EDWARDS AVE",
            "city": "MT PLEASANT",
            "state": "TX",
            "postal_code": "754552036",
            "telephone_number": "903-572-8551",
            "fax_number": "903-575-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2230 N EDWARDS AVE",
            "city": "MT PLEASANT",
            "state": "TX",
            "postal_code": "754552036",
            "telephone_number": "903-572-8551",
            "fax_number": "903-575-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKETT",
        "first_name": "ROBERT",
        "middle_name": "O.",
        "name_prefix": "Mr.",
        "credential": "LPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1015865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIP PROVIDER NUMBER",
            "identifier": "126772",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Pleasant, TX

All providers in Mt Pleasant, TX · Physical Therapist in Texas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.