Basic Information
| Provider Information | |||||||||
| NPI: | 1073704680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | PT, OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 SPRINGFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010851790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136425853 | ||||||||
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| Practice Location | |||||||||
| Address1: | 130 SOUTHAMPTON ROAD | ||||||||
| Address2: | |||||||||
| City: | WESTFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010850000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4136425853 | ||||||||
| FaxNumber: | 4136426153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 225100000X | 5226 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 9715568 | 05 | MA | MEDICAID |