Provider Demographics
NPI:1063236594
Name:CRAWFORD, CHARLOTTE (LMT)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 ARBOR MILL CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3216
Mailing Address - Country:US
Mailing Address - Phone:904-440-6909
Mailing Address - Fax:
Practice Address - Street 1:1950 EASTWEST PKWY STE 117
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6349
Practice Address - Country:US
Practice Address - Phone:904-999-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty