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General NPI Number Information
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NPI Number | 1780295121
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Entity Type | Individual
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Provider Name | MR. BRANDON ANTONIO CRAWFORD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 08/10/2020
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Provider Practice Location Address
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Address Line | 2800 CAHABA VILLAGE PLZ STE 240
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City | MOUNTAIN BRK
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State | AL
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Zip | 35243-5941
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Country | US
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Telephone | 205-834-8140
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Fax |
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Provider Business Mailing Address
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Address Line | 112 17TH AVE NW
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City | CENTER POINT
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State | AL
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Zip | 35215-5502
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Country | US
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Telephone | 205-305-2536
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 4676
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License Number State | AL
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