Provider Demographics
NPI:1467844753
Name:CRAWFORD, MICHEAL (MTI)
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 W PIONEER PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-4526
Mailing Address - Country:US
Mailing Address - Phone:682-551-2670
Mailing Address - Fax:
Practice Address - Street 1:3638 W PIONEER PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-4526
Practice Address - Country:US
Practice Address - Phone:682-551-2670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110851225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist