Provider Demographics
NPI:1801193800
Name:CRANE, CAROL (PTA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 VIENNA DR SPC 280
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-1832
Mailing Address - Country:US
Mailing Address - Phone:408-747-1542
Mailing Address - Fax:
Practice Address - Street 1:333 GELLERT DR., SUITE 150
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-758-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6385225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant