Crocker, Eddie Lee

Crocker, Eddie Lee is an individual health care provider with primary practice located at 1400 Shelby Dr , Dyersburg TN 38024-3435. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Crocker, Eddie Lee can be contacted via phone (731) 288-5056.

Contact Information

Primary practice address
1400 Shelby Dr Dyersburg TN 38024-3435
Phone: (731) 288-5056
Fax: (731) 288-5067
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT0000002313 Tennessee

Profile Details

NPI number 1316978612
LBN Legal business name Crocker, Eddie Lee
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Dec 18th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316978612 NPPES
Tennessee MEDICAID 1510385
Tennessee Other 4039751

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