MEDICARE: MS. NANCY E CRAWFORD PT

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
1	225100000X	Physical Therapist	00779	MO
2	2251P0200X	Pediatric Physical Therapist	00779	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326173469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY E CRAWFORD PT

Provider Business Mailing Address
First Line	:	19 WILSHIRE TER
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-4603
Country	:	US
Telephone Number	:	314-968-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S GARRISON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2538
Country	:	US
Telephone Number	:	314-340-5902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	05/19/2008

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