Basic Information
| Provider Information | |||||||||
| NPI: | 1962793315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAFT | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5120 DIXIE HWY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402161702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871236 | ||||||||
| FaxNumber: | 5025681873 | ||||||||
| Practice Location | |||||||||
| Address1: | 5120 DIXIE HWY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402161702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025871236 | ||||||||
| FaxNumber: | 5025681873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2011 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 005381 | KY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 005381 | 01 | KY | KENTUCKY LICENSE | OTHER |