MEDICARE: MR. AYDAN L CRANDALL 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	0400003297	VT

General Provider Information

NPI Number	:	1891941407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AYDAN L CRANDALL PT

Provider Business Mailing Address
First Line	:	81 RIVER ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-262-1500
Fax Number	:	802-262-1505

Provider Business Practice Location Address
First Line	:	81 RIVER ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-3792
Country	:	US
Telephone Number	:	802-262-1500
Fax Number	:	802-262-1505

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/09/2016

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