MEDICARE: MRS. BREANNA RENE CRAWFORD PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6040	OR

General Provider Information

NPI Number	:	1437381514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BREANNA RENE CRAWFORD PT

Provider Business Mailing Address
First Line	:	1129 NE 12TH ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4413
Country	:	US
Telephone Number	:	541-728-3559
Fax Number	:	541-241-3903

Provider Business Practice Location Address
First Line	:	1129 NE 12TH ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4413
Country	:	US
Telephone Number	:	541-728-3559
Fax Number	:	541-241-3903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	10/26/2020

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