Provider Demographics
NPI:1265750483
Name:CRAFTON, SANTRICE LAFONDA (CMT, MMP)
Entity type:Individual
Prefix:
First Name:SANTRICE
Middle Name:LAFONDA
Last Name:CRAFTON
Suffix:
Gender:F
Credentials:CMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-3822
Mailing Address - Country:US
Mailing Address - Phone:804-869-1799
Mailing Address - Fax:
Practice Address - Street 1:1518 WILLOW LAWN DR
Practice Address - Street 2:SUITE 319
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3419
Practice Address - Country:US
Practice Address - Phone:804-869-1799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006069225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA272266756OtherEIN