Ethan Andrew Crocker, DPT
Physical Medicine & Rehabilitation in Austin, MN. Individual provider (NPI-1).
NPI number1003531336
StatusActive
Last updated in NPPESOct 10, 2022
Details
- NPI
- 1003531336
- Entity type
- Individual (NPI-1)
- Name
- Ethan Andrew Crocker
- Credential
- DPT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 10, 2022
- Certification date
- Oct 10, 2022
- Last updated
- Oct 10, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | 12793 | MN | Yes |
Practice location
1000 1st Dr NwAustin, MN 55912-2941
Phone 507-433-8758
Mailing address
1000 1st Dr NwAustin, MN 55912-2941
Phone 507-433-8758
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