Provider Demographics
NPI:1992022065
Name:CRANDELL, CATHERINE ELIZABETH (C E CRANDELL, PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:C E CRANDELL, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 EVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1203
Mailing Address - Country:US
Mailing Address - Phone:502-553-0707
Mailing Address - Fax:
Practice Address - Street 1:2152 S HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1622
Practice Address - Country:US
Practice Address - Phone:502-499-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist