Healthcare Provider Details

I. General information

NPI: 1629707641
Provider Name (Legal Business Name): JOHNATHON CRAWLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 BRIGHTON BLVD
DENVER CO
80216-5023
US

IV. Provider business mailing address

3996 RED CEDAR DR UNIT A6
HIGHLANDS RANCH CO
80126-8066
US

V. Phone/Fax

Practice location:
  • Phone: 303-800-2829
  • Fax: 720-408-0320
Mailing address:
  • Phone: 303-800-2829
  • Fax: 720-408-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number0018390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: