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NPI Code Detail

MEDICARE: GWENDOLYN FRANCES CRAWFORD P.T.

MEDICARE: GWENDOLYN FRANCES CRAWFORD P.T.
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
1225100000XPhysical Therapist2151KY

General Provider Information

NPI Number : 1720142193
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN FRANCES CRAWFORD P.T.
Provider Business Mailing Address
First Line : PO BOX 950248
Second Line :
City : LOUISVILLE
State : KY
Zip : 40295-0248
Country : US
Telephone Number : 502-489-5730
Fax Number : 502-489-5733
Provider Business Practice Location Address
First Line : 11630 COMMONWEALTH DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2300
Country : US
Telephone Number : 502-267-6292
Fax Number : 502-267-6428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 12/03/2020

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