Active NPI
Charles Edward Crockatt, DPT
- Physical Therapist
- Cadillac, MI
National Provider Identifier
1760039689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501019303
- Practice address
- 8872 Professional Dr Ste C
Cadillac, MI 49601-8482 - Phone
- (231) 876-0010
- Fax
- (231) 876-1246
- NPI assigned
- Aug 26, 2019
- 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 | 5501019303 | MI | Primary |
Addresses
Primary practice location
8872 Professional Dr Ste C
Cadillac, MI 49601-8482
Mailing address
8872 Professional Dr Ste C
Cadillac, MI 49601-8482
Phone (231) 876-0010
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1760039689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8872 PROFESSIONAL DR STE C",
"city": "CADILLAC",
"state": "MI",
"postal_code": "496018482",
"telephone_number": "231-876-0010",
"fax_number": "231-876-1246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8872 PROFESSIONAL DR STE C",
"city": "CADILLAC",
"state": "MI",
"postal_code": "496018482",
"telephone_number": "231-876-0010",
"fax_number": "231-876-1246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKATT",
"first_name": "CHARLES",
"middle_name": "EDWARD",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-26",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501019303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cadillac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.