Provider Demographics
NPI:1154322816
Name:CRANDALL, STEVEN G (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S 900 E
Mailing Address - Street 2:#100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6657
Mailing Address - Country:US
Mailing Address - Phone:801-261-3321
Mailing Address - Fax:801-261-5972
Practice Address - Street 1:5151 S 900 E
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6601
Practice Address - Country:US
Practice Address - Phone:801-261-3321
Practice Address - Fax:801-261-5942
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118117-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5417OtherDMBA
UT870388269BR1OtherEDUCATORS MUTUAL
UT2738637001OtherCIGNA
UT65521OtherPEHP
UTCJ9402OtherRAILROAD MEDICARE
UT11811724000001OtherBLUE CROSS BLUE SHIELD
UT6400624OtherUNITED HEALTHCARE
UT11811724000001OtherBLUE CROSS BLUE SHIELD