Provider Demographics
NPI:1205316866
Name:CRAWLEY, JORDAN GRACE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:GRACE
Last Name:CRAWLEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:GRACE
Other - Last Name:FRIZZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1350 S GUTENSOHN
Mailing Address - Street 2:STE 10
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5117
Mailing Address - Country:US
Mailing Address - Phone:479-751-7122
Mailing Address - Fax:479-751-7292
Practice Address - Street 1:1350 S GUTENSOHN
Practice Address - Street 2:STE 10
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5117
Practice Address - Country:US
Practice Address - Phone:479-751-7122
Practice Address - Fax:479-751-7292
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131922742Medicaid