Provider Demographics
NPI:1073704680
Name:CRAWFORD, ROBERT (PT, OCS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1790
Mailing Address - Country:US
Mailing Address - Phone:413-642-5853
Mailing Address - Fax:
Practice Address - Street 1:130 SOUTHAMPTON ROAD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-0000
Practice Address - Country:US
Practice Address - Phone:413-642-5853
Practice Address - Fax:413-642-6153
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251H1200X
MA5226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9715568Medicaid
MA4510980001Medicare NSC
MA000571601Medicare PIN
MA9715568Medicaid