Maggi Crockett, PTA
Individual provider Active NPI Physical Therapy Assistant · Alsip, IL
NPI 1962852582 · NPPES record last updated Jun 14, 2016
Key facts
- NPI
- 1962852582
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.007483 (IL)
- Practice address
- 12052 S Cicero Ave
Alsip, IL 60803-2313 - Phone
- (708) 489-9940
- Fax
- (708) 489-9961
- NPI assigned
- Jun 14, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 160.007483 | IL | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.007483 | IL | Yes |
Addresses
Primary practice location
12052 S Cicero Ave
Alsip, IL 60803-2313
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Other providers in Alsip, IL
- Chicagoland Wellmed Center SC
- Iesha Coleman-Nwagwu
- Community Health Management and Family Services
- Rafael Cooke
- Craig Kostrubala DDS LLC
- Ankita Dalal
- George Pantelis Danos
- Aisha Daoud
- Abdul Hussein Darki
- Jeanette Orozco Delfino
All providers in Alsip, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2016. 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.