Provider Demographics
NPI:1114912904
Name:MOORHOUSE, CRAIG PAUL (ATC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:PAUL
Last Name:MOORHOUSE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALFALFA LN
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-3175
Mailing Address - Country:US
Mailing Address - Phone:423-202-2355
Mailing Address - Fax:
Practice Address - Street 1:1440 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-4118
Practice Address - Country:US
Practice Address - Phone:423-477-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN394OtherATHLETIC TRAINING LICENSE