Provider Demographics
NPI:1366824658
Name:CRAWFORD, GRACE I (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:I
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:I
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4848 S 76TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4361
Mailing Address - Country:US
Mailing Address - Phone:414-282-2899
Mailing Address - Fax:
Practice Address - Street 1:4848 S 76TH ST STE 203
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4361
Practice Address - Country:US
Practice Address - Phone:414-282-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13092-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13092-24OtherSTATE LICENSE