MEDICARE: MRS. JANE BRADLEY CRANE 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
1	225100000X	Physical Therapist	6778	GA

General Provider Information

NPI Number	:	1851499420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE BRADLEY CRANE P.T.

Provider Business Mailing Address
First Line	:	PO BOX 374
Second Line	:
City	:	PINE MOUNTAIN
State	:	GA
Zip	:	31822-0374
Country	:	US
Telephone Number	:	762-441-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	713 GARDENVIEW DRIVE
Second Line	:
City	:	PINE MOUNTAIN
State	:	GA
Zip	:	31822
Country	:	US
Telephone Number	:	762-441-0333
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/05/2023

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