Provider Demographics
NPI:1962077578
Name:CRAWFORD, BENJAMIN ORBIC (ATC, LAT, EMT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ORBIC
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:ATC, LAT, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 CARRIER ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15864-6301
Mailing Address - Country:US
Mailing Address - Phone:724-525-5766
Mailing Address - Fax:
Practice Address - Street 1:18 SPORTSMAN DR STE 10
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8572
Practice Address - Country:US
Practice Address - Phone:814-226-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0912140146N00000X
PART0073442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic