MEDICARE: GIDGETT LOUISE CRAWLEY

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		FL

General Provider Information

NPI Number	:	1679459135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIDGETT LOUISE CRAWLEY

Provider Business Mailing Address
First Line	:	2201 E MINNEHAHA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-1327
Country	:	US
Telephone Number	:	813-475-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 E MINNEHAHA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-1327
Country	:	US
Telephone Number	:	813-475-2636
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/12/2025

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Directions to “ GIDGETT LOUISE CRAWLEY ” Practice Location

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