Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT2529 | AR |
N | 2251P0200X | Physical Therapist - Pediatrics | PT2529 | AR |
NPI | 1104974468 |
---|---|
Provider Name | Mrs. Michelle R Cranford |
First Address | Little Rock, AR 72223 |
Second Address | Little Rock, AR 72223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 10/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145553721 | (05) | AR |
5W727 | BCBS (01) | AR |