Provider Demographics
NPI:1033115753
Name:BERTSCH, CRAIG F (PT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:F
Last Name:BERTSCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 JOYCE ANN LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-9519
Mailing Address - Country:US
Mailing Address - Phone:859-694-3713
Mailing Address - Fax:
Practice Address - Street 1:1400 GLORIA TERRELL DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076-9189
Practice Address - Country:US
Practice Address - Phone:859-781-2800
Practice Address - Fax:859-781-3500
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003529208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700147500Medicaid
KS0667001Medicare PIN
KY8700147500Medicaid
KY5017103Medicare PIN