Provider Demographics
NPI:1306013248
Name:CRAWFORD, GINA MARIE (LMP)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5440 FREELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9736
Mailing Address - Country:US
Mailing Address - Phone:369-579-2230
Mailing Address - Fax:
Practice Address - Street 1:5440 FREELAND AVE
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9736
Practice Address - Country:US
Practice Address - Phone:369-579-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024771225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist