Provider Demographics
NPI:1194735175
Name:CRAWLEY, SCOTT E (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:E
Last Name:CRAWLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 STOCKTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3590
Mailing Address - Country:US
Mailing Address - Phone:904-388-1300
Mailing Address - Fax:904-388-1302
Practice Address - Street 1:869 STOCKTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3590
Practice Address - Country:US
Practice Address - Phone:904-388-1300
Practice Address - Fax:904-388-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00245807OtherRAILROAD MEDICARE
FLY915QOtherBCBS PROVIDER NUMBER
FLK8401Medicare ID - Type Unspecified