Healthcare Provider Details

I. General information

NPI: 1750580098
Provider Name (Legal Business Name): STEPHANIE L CRAWFORD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 05/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 YMCA DR SUITE 5
MADISONVILLE KY
42431-9000
US

IV. Provider business mailing address

100 YMCA DR SUITE 5
MADISONVILLE KY
42431-9000
US

V. Phone/Fax

Practice location:
  • Phone: 270-824-9227
  • Fax: 270-824-9206
Mailing address:
  • Phone: 270-824-9227
  • Fax: 270-824-9206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002534
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: