MEDICARE: MR. ALLEN GEORMARIO CRAWFORD MS, ATC

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	2255A2300X	Athletic Trainer	AT 304	AR

General Provider Information

NPI Number	:	1548281033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN GEORMARIO CRAWFORD MS, ATC

Provider Business Mailing Address
First Line	:	12240 MARYLAND PL
Second Line	:
City	:	SHERWOOD
State	:	AR
Zip	:	72120-3090
Country	:	US
Telephone Number	:	501-766-4251
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 DONAGHEY AVE
Second Line	:	PRINCE CENTER 127
City	:	CONWAY
State	:	AR
Zip	:	72035-5001
Country	:	US
Telephone Number	:	501-450-3214
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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