Provider Demographics
NPI:1942823752
Name:CRAWFORD, EMILY RAE (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE
Last Name:CRAWFORD
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 1:824 COUNTY ROAD 343
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-7668
Mailing Address - Country:US
Mailing Address - Phone:870-321-7062
Mailing Address - Fax:
Practice Address - Street 1:347 HIGHWAY 62 E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3655
Practice Address - Country:US
Practice Address - Phone:870-321-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020013688225200000X
AR4603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant