Provider Demographics
NPI:1164783650
Name:CRAWFORD, LISA DAWN (LPTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41733 ROYAL TRAILS RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-8153
Mailing Address - Country:US
Mailing Address - Phone:352-589-0788
Mailing Address - Fax:
Practice Address - Street 1:15745 DORA AVE STE B
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4943
Practice Address - Country:US
Practice Address - Phone:352-357-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23289225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant