Basic Information
| Provider Information | |||||||||
| NPI: | 1528265048 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | RMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6979 S HOLLY CIR | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CENTENNIAL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801121577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036942295 | ||||||||
| FaxNumber: | 3036941843 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 PROFESSIONAL LN | ||||||||
| Address2: | STE 145 | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805016972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204943290 | ||||||||
| FaxNumber: | 7204943294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 08/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 102072963 | 01 | OWCP PROVIDER NUMBER | OTHER |