Active NPI
Derrick Antonia Crawford, PTA
- Physical Therapy Assistant
- Omaha, NE
National Provider Identifier
1659659688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 481
- Practice address
- 12856 Deauville Dr
Omaha, NE 68137-3204 - Phone
- (402) 895-2266
- Fax
- (402) 895-2840
- NPI assigned
- Jul 25, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 481 | NE | Primary |
Addresses
Primary practice location
12856 Deauville Dr
Omaha, NE 68137-3204
Mailing address
2107 Dover CT
Bellevue, NE 68005-4366
Phone (402) 895-2266
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 481 | NE | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311552000000",
"number": "1659659688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2107 DOVER CT",
"city": "BELLEVUE",
"state": "NE",
"postal_code": "680054366",
"telephone_number": "402-895-2266",
"fax_number": "402-895-2840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12856 DEAUVILLE DR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681373204",
"telephone_number": "402-895-2266",
"fax_number": "402-895-2840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRAWFORD",
"first_name": "DERRICK",
"middle_name": "ANTONIA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-25",
"last_updated": "2011-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NE",
"license": "481",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.