Provider Demographics
NPI:1255389128
Name:CROWDER, EDWARD D (PT)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:D
Last Name:CROWDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:DUNCAN
Other - Middle Name:E
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:33310 US HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-3121
Mailing Address - Country:US
Mailing Address - Phone:256-378-3390
Mailing Address - Fax:
Practice Address - Street 1:33310 US HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-3121
Practice Address - Country:US
Practice Address - Phone:256-378-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL73309Medicare ID - Type UnspecifiedPT