Provider Demographics
NPI:1134319486
Name:BERTELSEN, CRAIG S (PT, CERT MDT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:BERTELSEN
Suffix:
Gender:M
Credentials:PT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:715 HWY 45
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-0366
Mailing Address - Country:US
Mailing Address - Phone:662-365-5610
Mailing Address - Fax:662-365-5611
Practice Address - Street 1:715 HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-8591
Practice Address - Country:US
Practice Address - Phone:662-365-5610
Practice Address - Fax:662-365-5611
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist