Provider Demographics
NPI:1619190329
Name:CRUTCHFIELD, KEVIN DELANE
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DELANE
Last Name:CRUTCHFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5713
Mailing Address - Country:US
Mailing Address - Phone:432-697-6377
Mailing Address - Fax:
Practice Address - Street 1:2215 N MIDLAND DR
Practice Address - Street 2:4-A
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5500
Practice Address - Country:US
Practice Address - Phone:432-889-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist