Provider Demographics
NPI:1407242886
Name:CRANE, SHELLEY (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W HONONEGH DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3767
Mailing Address - Country:US
Mailing Address - Phone:623-349-3212
Mailing Address - Fax:
Practice Address - Street 1:34225 N 27TH DR STE 149
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6087
Practice Address - Country:US
Practice Address - Phone:623-349-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-09990225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist