Active NPI
David Howard Crenshaw, L.P.T.
- Physical Therapist
- Eureka, IL
National Provider Identifier
1417036377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.004852
- Practice address
- 120 N Main Street
Eureka, IL 61530-1182 - Phone
- (309) 467-3220
- Fax
- (309) 467-3240
- NPI assigned
- Nov 3, 2006
- Last updated
- Sep 11, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.004852 | IL | Primary |
Addresses
Primary practice location
120 N Main Street
Eureka, IL 61530-1182
Mailing address
211 Landmark Dr
Ste E3
Normal, IL 61761-6165
Phone (309) 467-3220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10232007 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.004852 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599782400000",
"number": "1417036377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "211 LANDMARK DR",
"address_2": "STE E3",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616165",
"telephone_number": "309-467-3220",
"fax_number": "309-467-3240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 N MAIN STREET",
"city": "EUREKA",
"state": "IL",
"postal_code": "615301182",
"telephone_number": "309-467-3220",
"fax_number": "309-467-3240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRENSHAW",
"first_name": "DAVID",
"middle_name": "HOWARD",
"name_prefix": "Mr.",
"credential": "L.P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-03",
"last_updated": "2020-09-11",
"certification_date": "2020-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.004852",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "10232007",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eureka, IL
- Carle Eureka Hospital (Advocate Eureka Hospital)
- Carle Eureka Hospital (Carle Eureka Family Medicine - Eureka)
- Benjamin Robert Coleman, MD
- Jason Collins, SSP
- County of Woodford Eureka Congerville Goodfld Dist 140
- Michael T Detweiler, D.C.
- Victoria L Diekhoff, LMT
- Elite Chiropractic Services, LLC
- Erika Quinn Psychotherapy LLC
- Eureka Community Hospital
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.