Provider Demographics
NPI:1891912606
Name:CRAWFORD, CLINTON DWAYNE (MSPT)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:DWAYNE
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PINE RIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8913
Mailing Address - Country:US
Mailing Address - Phone:239-261-2663
Mailing Address - Fax:239-262-5633
Practice Address - Street 1:1250 PINE RIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8913
Practice Address - Country:US
Practice Address - Phone:239-261-2663
Practice Address - Fax:239-262-5633
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21462OtherLICENSE NUMBER