Provider Demographics
NPI:1215435698
Name:CRAWFORD, RODNEY KIT (PTA, AT,C)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:KIT
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PTA, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 N SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-7829
Mailing Address - Country:US
Mailing Address - Phone:812-482-9179
Mailing Address - Fax:
Practice Address - Street 1:600 W 13TH ST STE 200
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1883
Practice Address - Country:US
Practice Address - Phone:812-482-7441
Practice Address - Fax:812-482-7444
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003823A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant