Most Relevant Information
Provider Data
| NPI Number: | 1003531336 |
| Provider Name: | ETHAN ANDREW CROCKER DPT |
| Entity Type: | Individual |
| Taxonomy Code: | 208100000X |
| Specialty: | Physical Medicine & Rehabilitation |
| License Number: | 12793 |
Most Important Dates
| Enumeration Date: | 10/10/2022 |
| Last Updated: | 10/10/2022 |
Provider Practice Location
1000 1ST DR NW
AUSTIN
MN
559122941
Practice Location Phone/Fax
| Phone: | 5074338758 |
| Fax: |
Provider Mailing Location
1000 1ST DR NW
AUSTIN
MN
559122941
Provider Mailing Phone/Fax
| Phone: | 5074338758 |
| Fax: |