Provider Demographics
NPI:1053065565
Name:CRAIG, COREY MICHAELA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MICHAELA
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S MONACO ST APT 1833
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3414
Mailing Address - Country:US
Mailing Address - Phone:520-850-7282
Mailing Address - Fax:
Practice Address - Street 1:873 LAKE GULCH RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-9746
Practice Address - Country:US
Practice Address - Phone:303-817-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty