Provider Demographics
NPI:1275073934
Name:CRAWFORD, AYLEN (PTA)
Entity Type:Individual
Prefix:
First Name:AYLEN
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 NW 97TH AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4150
Mailing Address - Country:US
Mailing Address - Phone:407-421-3133
Mailing Address - Fax:
Practice Address - Street 1:4850 W OAKLAND PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7268
Practice Address - Country:US
Practice Address - Phone:954-735-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27212225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant