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General NPI Number Information
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NPI Number | 1811701063
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Entity Type | Individual
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Provider Name | GRACE SAMANTHA CRAWFORD ATC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 185 TILLEY DR
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-4484
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Country | US
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Telephone | 802-879-1703
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Fax |
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Provider Business Mailing Address
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Address Line | 19 HIGHWOOD TER
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1512
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Country | US
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Telephone | 551-804-8077
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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 | 104.0134045
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License Number State | VT
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