Provider Demographics
NPI:1003874926
Name:CRAVEN, NANCY ANN (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06034
Mailing Address - Country:US
Mailing Address - Phone:860-679-3233
Mailing Address - Fax:860-679-1425
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06034
Practice Address - Country:US
Practice Address - Phone:860-679-3233
Practice Address - Fax:860-679-1425
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004223038Medicaid
CT080007107CT01OtherBC&BS ID NUMBER
CT650000741Medicare ID - Type Unspecified