Provider Demographics
NPI:1285937169
Name:CREWS, JENNIFER D (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:CREWS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 RAND AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9126
Mailing Address - Country:US
Mailing Address - Phone:251-210-1632
Mailing Address - Fax:251-625-3152
Practice Address - Street 1:8909 RAND AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9126
Practice Address - Country:US
Practice Address - Phone:251-210-1632
Practice Address - Fax:251-625-3152
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH5915OtherALABAMA BOARD OF PHYSICAL THERAPY
MS1033218524OtherGROUP NPI
MS09015077Medicaid