Provider Demographics
NPI:1043416233
Name:CRANDALL, LAURA L (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:CRANDALL
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 1:115 MEDICAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3105
Mailing Address - Country:US
Mailing Address - Phone:361-578-7713
Mailing Address - Fax:361-572-0013
Practice Address - Street 1:115 MEDICAL DR STE 105
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3105
Practice Address - Country:US
Practice Address - Phone:361-578-7713
Practice Address - Fax:361-572-0013
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT74232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic