Healthcare Provider Details

I. General information

NPI: 1639887698
Provider Name (Legal Business Name): MATTIE CLAIRE CRANFIELD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax: 832-825-2301
Mailing address:
  • Phone: 832-824-1000
  • Fax: 832-825-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11202
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: