Provider Demographics
NPI:1144573163
Name:MEYER, CRAIG (PTA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-5502
Mailing Address - Country:US
Mailing Address - Phone:843-325-1380
Mailing Address - Fax:
Practice Address - Street 1:1861 EAGLE VIEW CIR
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-1818
Practice Address - Country:US
Practice Address - Phone:507-373-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2284225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant