Provider Demographics
NPI:1891941407
Name:CRANDALL, AYDAN L (PT)
Entity Type:Individual
Prefix:MR
First Name:AYDAN
Middle Name:L
Last Name:CRANDALL
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 1:81 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3792
Mailing Address - Country:US
Mailing Address - Phone:802-262-1500
Mailing Address - Fax:802-262-1505
Practice Address - Street 1:81 RIVER ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3792
Practice Address - Country:US
Practice Address - Phone:802-262-1500
Practice Address - Fax:802-262-1505
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist