Provider Demographics
NPI:1437381514
Name:CRAWFORD, BREANNA RENE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:RENE
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BREANNA
Other - Middle Name:RENE
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1129 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4413
Mailing Address - Country:US
Mailing Address - Phone:541-728-3559
Mailing Address - Fax:541-241-3903
Practice Address - Street 1:1129 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4413
Practice Address - Country:US
Practice Address - Phone:541-728-3559
Practice Address - Fax:541-241-3903
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist