Healthcare Provider Details

I. General information

NPI: 1134044951
Provider Name (Legal Business Name): JENNIFER GRACE CRAWLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W CHEROKEE ST
WAGONER OK
74467-4616
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 918-485-3100
  • Fax: 918-485-3126
Mailing address:
  • Phone: 726-202-3039
  • Fax: 210-978-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7138
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: