Provider Demographics
NPI:1811013089
Name:CRANDALL-WILLIAMS, CHERYL JEAN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:JEAN
Last Name:CRANDALL-WILLIAMS
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BRITTANY LOOP
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5078
Mailing Address - Country:US
Mailing Address - Phone:928-699-3142
Mailing Address - Fax:
Practice Address - Street 1:30336 HIGHWAY 200 STE B
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-9775
Practice Address - Country:US
Practice Address - Phone:208-265-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6173225100000X
ID2241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist