Provider Demographics
NPI:1548320377
Name:CRANDALL, STEVEN WAYNE (MSPT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1421
Mailing Address - Country:US
Mailing Address - Phone:410-923-9468
Mailing Address - Fax:410-923-2610
Practice Address - Street 1:810 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1421
Practice Address - Country:US
Practice Address - Phone:410-923-9468
Practice Address - Fax:410-923-2610
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028862225100000X
MD22339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist