Healthcare Provider Details

I. General information

NPI: 1780065102
Provider Name (Legal Business Name): RACHELLE MARIE CRAWFORD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 HICKORY LOOP
LAS CRUCES NM
88005-6502
US

IV. Provider business mailing address

301 PERKINS DR STE B
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-3773
  • Fax: 575-647-3777
Mailing address:
  • Phone: 575-652-3155
  • Fax: 575-652-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4152
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: