Basic Information
| Provider Information | |||||||||
| NPI: | 1922072610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOLL | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ATC, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2142 OLD OAK DR | ||||||||
| Address2: | |||||||||
| City: | WEST LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479069701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654631706 | ||||||||
| FaxNumber: | 7654949899 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 N UNIVERSITY ST | ||||||||
| Address2: | B-63 MACKEY ARENA | ||||||||
| City: | WEST LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479072070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654966762 | ||||||||
| FaxNumber: | 7654949899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 05006565A | IN | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2255A2300X | 36000529A | IN | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.