Individual provider Active NPI

Marcy Lynn Crouch, PT, DPT

  • Physical Therapist
  • Portland, OR
National Provider Identifier
1578853958
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTH10253 Issued in AL
Practice address
4876 NW Bethany Blvd
Suite L-1
Portland, OR 97229-9259
Phone
(503) 466-2254
Fax
(503) 466-1143
NPI assigned
Apr 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 37785 CA
Physical Therapist 225100000X 60493 OR
Physical Therapist 225100000X PTH10253 AL Primary

Addresses

Primary practice location

4876 NW Bethany Blvd
Suite L-1
Portland, OR 97229-9259

Mailing address

16083 SW Upper Boones Ferry Rd
Suite 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other practice location 1

1111 S College St Unit 200
Auburn, AL 36832-5984
Phone (334) 521-1610

Other identifiers 1

IdentifierTypeStateIssuer
500706471MedicaidOR

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

LicenseStateTypeSpecialty
PTH10253ALMDPhysical Therapist
37785CAMDPhysical Therapist
60493ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Benchmark Physical Therapy of Alabama, LLC Physical Therapist CurrentSince Aug 29, 2022 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Benchmark Physical Therapy of Alabama, LLC Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1578853958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD",
            "address_2": "SUITE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4876 NW BETHANY BLVD",
            "address_2": "SUITE L-1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972299259",
            "telephone_number": "503-466-2254",
            "fax_number": "503-466-1143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 S College St Unit 200",
            "address_purpose": "LOCATION",
            "city": "Auburn",
            "state": "AL",
            "postal_code": "368325984",
            "country_code": "US",
            "telephone_number": "334-521-1610",
            "fax_number": "334-833-1852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CROUCH",
        "first_name": "MARCY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "37785",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "60493",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH10253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500706471",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.