Provider Demographics
NPI:1245439181
Name:CRAWFORD, MARYANNE REGINA (PT)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:REGINA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARYANNE
Other - Middle Name:REGINA
Other - Last Name:SLEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1606 CRESTON DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2311
Mailing Address - Country:US
Mailing Address - Phone:410-803-9056
Mailing Address - Fax:
Practice Address - Street 1:2191 DEFENSE HWY STE 102
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2487
Practice Address - Country:US
Practice Address - Phone:301-261-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist