Provider Demographics
NPI:1063517217
Name:CRAWFORD, ANGELA JOY (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JOY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:JOY
Other - Last Name:GROHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12569 TROPIC DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6234
Mailing Address - Country:US
Mailing Address - Phone:904-718-9335
Mailing Address - Fax:904-221-2726
Practice Address - Street 1:12569 TROPIC DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6234
Practice Address - Country:US
Practice Address - Phone:904-718-9335
Practice Address - Fax:904-221-2726
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist