Provider Demographics
NPI:1083121198
Name:COATS, CRAIG ALLEN (ATC/L, CA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALLEN
Last Name:COATS
Suffix:
Gender:M
Credentials:ATC/L, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14096 W BANFF LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8608
Mailing Address - Country:US
Mailing Address - Phone:480-734-6995
Mailing Address - Fax:
Practice Address - Street 1:2625 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7042
Practice Address - Country:US
Practice Address - Phone:602-919-0486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer