Provider Demographics
NPI:1346332608
Name:CRANE, PEG (PT)
Entity Type:Individual
Prefix:
First Name:PEG
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646-0264
Mailing Address - Country:US
Mailing Address - Phone:701-824-2871
Mailing Address - Fax:
Practice Address - Street 1:103 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:MOTT
Practice Address - State:ND
Practice Address - Zip Code:58646
Practice Address - Country:US
Practice Address - Phone:701-824-2871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND59120OtherBLUE CROSS
ND59120Medicaid
ND59120Medicaid