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NPI Code Detail

MEDICARE: DERRICK ANTONIA CRAWFORD PTA

MEDICARE: DERRICK ANTONIA 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 Assistant481NE

General Provider Information

NPI Number : 1659659688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK ANTONIA CRAWFORD PTA
Provider Business Mailing Address
First Line : 2107 DOVER CT
Second Line :
City : BELLEVUE
State : NE
Zip : 68005-4366
Country : US
Telephone Number : 402-895-2266
Fax Number : 402-895-2840
Provider Business Practice Location Address
First Line : 12856 DEAUVILLE DR
Second Line :
City : OMAHA
State : NE
Zip : 68137-3204
Country : US
Telephone Number : 402-895-2266
Fax Number : 402-895-2840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2011
Last Update Date : 07/25/2011

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