Provider Demographics
NPI:1255699815
Name:CROW, BENNET STEWART (CMT)
Entity type:Individual
Prefix:
First Name:BENNET
Middle Name:STEWART
Last Name:CROW
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3424
Mailing Address - Country:US
Mailing Address - Phone:952-270-4945
Mailing Address - Fax:
Practice Address - Street 1:684 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-1980
Practice Address - Country:US
Practice Address - Phone:952-270-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist