Individual
DERRICK DEWAYNE CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4701 OLD HICKORY BLVD APT C202, OLD HICKORY, TN 37138-2073
(615) 339-7583
Mailing address
4701 OLD HICKORY BLVD APT C202, OLD HICKORY, TN 37138-2073
(615) 339-7583
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
9309
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9309
LICENSED MASSAGE THERAPIST
TN
Enumeration date
10/16/2020
Last updated
10/16/2020
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