Provider Demographics
NPI:1366470460
Name:CRAWLEY, VICTORIA LOUISE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LOUISE
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:ERB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:6920 GATWICK DR
Practice Address - Street 2:STE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9504
Practice Address - Country:US
Practice Address - Phone:317-856-1162
Practice Address - Fax:317-821-0455
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007589A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000514445OtherANTHEM
IN555850031Medicare PIN
IN318840QMedicare PIN