Provider Demographics
NPI:1366774341
Name:CROWDER, WARREN
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:CROWDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 METZLER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7625
Mailing Address - Country:US
Mailing Address - Phone:303-663-3702
Mailing Address - Fax:303-200-8853
Practice Address - Street 1:323 METZLER DR STE 105
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7625
Practice Address - Country:US
Practice Address - Phone:303-663-3702
Practice Address - Fax:303-200-8853
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist