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NPI Code Detail

MEDICARE: GRACE FLORENCE CRAWFORD PTA

MEDICARE:   GRACE FLORENCE CRAWFORD  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2120972TX

General Provider Information

NPI Number : 1265913909
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE FLORENCE CRAWFORD PTA
Provider Business Mailing Address
First Line : 1855 SWINGING BRIDGE RD
Second Line :
City : LONGVIEW
State : TX
Zip : 75604-5686
Country : US
Telephone Number : 903-918-1264
Fax Number :
Provider Business Practice Location Address
First Line : 1154 E HAWKINS PKWY
Second Line :
City : LONGVIEW
State : TX
Zip : 75605-7975
Country : US
Telephone Number : 903-663-2750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2018
Last Update Date : 08/21/2018

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Directions to “ GRACE FLORENCE CRAWFORD PTA” Practice Location

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