Healthcare Provider Details

I. General information

NPI: 1144627738
Provider Name (Legal Business Name): JEFF CRAWFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WESTMINSTER DR
FRONT ROYAL VA
22630-3766
US

IV. Provider business mailing address

121 BUCHANNAN DR
STEPHENS CITY VA
22655-3809
US

V. Phone/Fax

Practice location:
  • Phone: 540-635-4144
  • Fax:
Mailing address:
  • Phone: 540-868-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126000812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: