Healthcare Provider Details

I. General information

NPI: 1306028162
Provider Name (Legal Business Name): FUNCTIONAL OUTCOME THERAPY SERVICES, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BOURNEMOUTH BND
WILLIAMSBURG VA
23188-6637
US

IV. Provider business mailing address

3959 BOURNEMOUTH BND
WILLIAMSBURG VA
23188-6637
US

V. Phone/Fax

Practice location:
  • Phone: 757-634-9842
  • Fax:
Mailing address:
  • Phone: 757-869-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305204567
License Number StateVA

VIII. Authorized Official

Name: DR. FREDRICK E CRAWFORD JR.
Title or Position: PHYSICAL THERAPIST/PRESIDENT
Credential: DPT
Phone: 757-634-9842