Provider Demographics
NPI:1023582954
Name:CROCKFORD, SIERRA MARIE (PT)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:MARIE
Last Name:CROCKFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:940 SPOKANE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2931
Mailing Address - Country:US
Mailing Address - Phone:406-862-4540
Mailing Address - Fax:406-890-7193
Practice Address - Street 1:940 SPOKANE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2931
Practice Address - Country:US
Practice Address - Phone:406-862-4540
Practice Address - Fax:406-890-7193
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-17145225100000X, 225100000X
UT11108941-2401225100000X
ORCP000096T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist