Eddie Lee Crocker, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT0000002313 Issued in TN

Practice address

1400 Shelby Dr
Dyersburg, TN 38024-3435

Phone

(731) 288-5056

Fax

(731) 288-5067

NPI assigned

Jul 5, 2006

Last updated

Dec 18, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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.

• PT Company

  • Physical Therapist
  • Dyersburg, TN
  • NPI 1508532698
  NPD (past)
• PT Company

  • Physical Therapist
  • Dyersburg, TN
  • NPI 1619992450
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1316978612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 SHELBY DR",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243435",
            "telephone_number": "731-288-5056",
            "fax_number": "731-288-5067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SHELBY DR",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243435",
            "telephone_number": "731-288-5056",
            "fax_number": "731-288-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROCKER",
        "first_name": "EDDIE",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT0000002313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1510385",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "4039751",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Wade Cook, PHARMACIST
• Erica Cornelison, OTD, OTR/L
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• Brad F Creekmore, FNP
• Patsy Elaine Crihfield, MSN, RN, APRN, BC
• Crossroads Urgent Care PLLC (Urgent Team)
• Crossroads Urgent Care PLLC (Urgent Team)
• Emily Rose Crum
• Kerri B Cunningham
• Da Dove Transportation LLC

• Physical Therapist in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; 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.