Provider Demographics
NPI:1093877284
Name:PATE, CRAIG S (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:PATE
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 1:101 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-8071
Mailing Address - Country:US
Mailing Address - Phone:985-449-0346
Mailing Address - Fax:530-690-7721
Practice Address - Street 1:104 E BAYOU RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3036
Practice Address - Country:US
Practice Address - Phone:985-446-3736
Practice Address - Fax:985-446-3701
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C562CD96Medicare ID - Type Unspecified