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General NPI Number Information
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NPI Number | 1447612015
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Entity Type | Individual
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Provider Name | MATTHEW CRUMLEY
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Gender | Male
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 9040A JACKSON AVE
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98431-3102
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Country | US
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Telephone | 253-968-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 707 89TH AVE SW
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City | OLYMPIA
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State | WA
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Zip | 98512-7627
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Country | US
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Telephone | 405-388-5061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 425
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 61253652
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License Number State | WA
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