Healthcare Provider Details

I. General information

NPI: 1306339536
Provider Name (Legal Business Name): HAILEY M CRAWFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-3323
US

IV. Provider business mailing address

9469 AMBERSTONE LN APT 1517
NOBLESVILLE IN
46060-5335
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-1037
  • Fax:
Mailing address:
  • Phone: 260-343-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06005096A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: