Provider Demographics
NPI:1013404714
Name:CRAFTED PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:CRAFTED PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWLINGS
Authorized Official - Suffix:IV
Authorized Official - Credentials:PT, DPT, COMT, OCS
Authorized Official - Phone:720-204-4567
Mailing Address - Street 1:701 DELAWARE AVE UNIT E
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6498
Mailing Address - Country:US
Mailing Address - Phone:720-204-4567
Mailing Address - Fax:720-204-4568
Practice Address - Street 1:701 DELAWARE AVE UNIT E
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:720-204-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty