Basic Information
| Provider Information | |||||||||
| NPI: | 1902934284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVINE | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.T., A.T.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430409198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376443931 | ||||||||
| FaxNumber: | 6142735636 | ||||||||
| Practice Location | |||||||||
| Address1: | 4605 SAWMILL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142735633 | ||||||||
| FaxNumber: | 6142735636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-07472 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.