Healthcare Provider Details

I. General information

NPI: 1407775463
Provider Name (Legal Business Name): MADELINE ELYZE CRAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 E WASHINGTON ST STE 206
INDIANAPOLIS IN
46229-3032
US

IV. Provider business mailing address

9650 E WASHINGTON ST STE 206
INDIANAPOLIS IN
46229-3032
US

V. Phone/Fax

Practice location:
  • Phone: 317-890-5624
  • Fax: 317-890-5625
Mailing address:
  • Phone: 317-890-5624
  • Fax: 317-890-5625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05015620A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: