Provider Demographics
NPI:1568595353
Name:CRANE, MORELL S JR (PT)
Entity Type:Individual
Prefix:MR
First Name:MORELL
Middle Name:S
Last Name:CRANE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVER RD STE 112
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4226
Mailing Address - Country:US
Mailing Address - Phone:504-828-7696
Mailing Address - Fax:504-828-8935
Practice Address - Street 1:101 RIVER RD STE 112
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4226
Practice Address - Country:US
Practice Address - Phone:504-828-7696
Practice Address - Fax:504-828-8935
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT01635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1129364Medicaid
LA1129364Medicaid