Healthcare Provider Details

I. General information

NPI: 1265018394
Provider Name (Legal Business Name): CHRISTOPHER DAVID CROWDER SPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MARYLAND AVE
ANNAPOLIS MD
21401-1694
US

IV. Provider business mailing address

73 MARYLAND AVE
ANNAPOLIS MD
21401-1694
US

V. Phone/Fax

Practice location:
  • Phone: 757-746-4720
  • Fax:
Mailing address:
  • Phone: 757-746-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: