Healthcare Provider Details

I. General information

NPI: 1134058183
Provider Name (Legal Business Name): DR. LEE EARL CRAWFORD IV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7850 VAUGHN RD
MONTGOMERY AL
36116-1333
US

IV. Provider business mailing address

62 MOSSEY LN
MILLBROOK AL
36054-2552
US

V. Phone/Fax

Practice location:
  • Phone: 334-396-2110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH12663
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: