Provider Demographics
NPI:1669956728
Name:CRAWFORD, AMETHYST MORIAH (LAT, ATC)
Entity type:Individual
Prefix:
First Name:AMETHYST
Middle Name:MORIAH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 BRITTONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:TN
Mailing Address - Zip Code:37616-3951
Mailing Address - Country:US
Mailing Address - Phone:423-525-7616
Mailing Address - Fax:
Practice Address - Street 1:2515 BRITTONTOWN RD
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:TN
Practice Address - Zip Code:37616-3951
Practice Address - Country:US
Practice Address - Phone:423-525-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000025932255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer