Individual
ABIGAIL DAWN CRANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
36 WINN DR STE 100, REXBURG, ID 83440-5277
(208) 356-0174
(208) 356-0176
Mailing address
1209 N 990 E, SHELLEY, ID 83274-5177
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA8612
ID
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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