Provider Demographics
NPI:1124386081
Name:CRAZE, MARYANN (LMT MMP)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:CRAZE
Suffix:
Gender:F
Credentials:LMT MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45030 W PORTABELLO RD
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-8779
Mailing Address - Country:US
Mailing Address - Phone:480-335-2225
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 109
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:480-335-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist