Provider Demographics
NPI:1619055969
Name:CRAWFORD, MARC THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:THOMAS
Last Name:CRAWFORD
Suffix:
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:PO BOX 5024
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44061-5024
Mailing Address - Country:US
Mailing Address - Phone:440-290-4437
Mailing Address - Fax:440-290-4438
Practice Address - Street 1:600 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3933
Practice Address - Country:US
Practice Address - Phone:440-992-3594
Practice Address - Fax:440-290-4438
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist