Provider Demographics
NPI:1134165962
Name:CRAWFORD, MILDRED (MPT)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PINEY FOREST RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DANVILLED
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4154
Mailing Address - Country:US
Mailing Address - Phone:434-793-0700
Mailing Address - Fax:434-793-9315
Practice Address - Street 1:441 PINEY FOREST RD
Practice Address - Street 2:SUITE G
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4154
Practice Address - Country:US
Practice Address - Phone:434-793-0700
Practice Address - Fax:434-793-9315
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP08836Medicare UPIN