Provider Demographics
NPI:1144604737
Name:CROFFORD, WAYNE MANUEL (RRT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:MANUEL
Last Name:CROFFORD
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-9501
Mailing Address - Country:US
Mailing Address - Phone:210-445-1963
Mailing Address - Fax:
Practice Address - Street 1:100 DEER RIDGE DR
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-9501
Practice Address - Country:US
Practice Address - Phone:210-445-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78399227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered