Provider Demographics
NPI:1306028162
Name:FUNCTIONAL OUTCOME THERAPY SERVICES, INCORPORATED
Entity Type:Organization
Organization Name:FUNCTIONAL OUTCOME THERAPY SERVICES, INCORPORATED
Other - Org Name:FUNCTIONAL OUTCOME THERAPY SERVICES, INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-634-9842
Mailing Address - Street 1:3959 BOURNEMOUTH BND
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6637
Mailing Address - Country:US
Mailing Address - Phone:757-869-2544
Mailing Address - Fax:
Practice Address - Street 1:3959 BOURNEMOUTH BND
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-6637
Practice Address - Country:US
Practice Address - Phone:757-634-9842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204567261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy