Provider Demographics
NPI:1235463068
Name:CRAWFORD, LORI ANN (LMT,REFLEXOLOGIST)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMT,REFLEXOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 STATE ROAD 590
Mailing Address - Street 2:9
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-5503
Mailing Address - Country:US
Mailing Address - Phone:727-725-9193
Mailing Address - Fax:727-725-9193
Practice Address - Street 1:2907 STATE ROAD 590
Practice Address - Street 2:9
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-5503
Practice Address - Country:US
Practice Address - Phone:727-725-9193
Practice Address - Fax:727-725-9193
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA00014517173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC6412OtherBLUE CROSS BLUE SHIELD