Individual
PEG CRANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
103 MONTANA AVE, MOTT, ND 58646
(701) 824-2871
Mailing address
PO BOX 264, MOTT, ND 58646-0264
(701) 824-2871
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
357
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59120
BLUE CROSS
ND
05
—
59120
—
ND
Enumeration date
09/28/2006
Last updated
07/08/2007
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