Healthcare Provider Details

I. General information

NPI: 1134165962
Provider Name (Legal Business Name): MILDRED CRAWFORD M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 PINEY FOREST RD SUITE G
DANVILLE VA
24540-4154
US

IV. Provider business mailing address

441 PINEY FOREST RD SUITE G
DANVILLED VA
24540-4154
US

V. Phone/Fax

Practice location:
  • Phone: 434-793-0700
  • Fax: 434-793-9315
Mailing address:
  • Phone: 434-793-0700
  • Fax: 434-793-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2305006802
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: