Basic Information
Provider Information | |||||||||
NPI: | 1003292020 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRANE | ||||||||
FirstName: | EVAINE | ||||||||
MiddleName: | DELANEY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NIEDER | ||||||||
OtherFirstName: | EVAINE | ||||||||
OtherMiddleName: | DELANEY | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DPT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3825 TRUEMAN CT | ||||||||
Address2: |   | ||||||||
City: | HILLIARD | ||||||||
State: | OH | ||||||||
PostalCode: | 430262496 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6143341898 | ||||||||
FaxNumber: | 6143342020 | ||||||||
Practice Location | |||||||||
Address1: | 3825 TRUEMAN CT | ||||||||
Address2: |   | ||||||||
City: | HILLIARD | ||||||||
State: | OH | ||||||||
PostalCode: | 430262496 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6143341898 | ||||||||
FaxNumber: | 6143342020 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2015 | ||||||||
LastUpdateDate: | 07/31/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14770 | OH | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.