Provider Demographics
NPI:1871606319
Name:CROTHERS, DONN W (PTA/LMT)
Entity type:Individual
Prefix:
First Name:DONN
Middle Name:W
Last Name:CROTHERS
Suffix:
Gender:M
Credentials:PTA/LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 SW 186TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1414
Mailing Address - Country:US
Mailing Address - Phone:954-384-2977
Mailing Address - Fax:954-384-8241
Practice Address - Street 1:5330 SW 186TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33332-1414
Practice Address - Country:US
Practice Address - Phone:954-384-2977
Practice Address - Fax:954-384-8241
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA002200225200000X
FLMA2739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2271Medicare UPIN