Provider Demographics
NPI:1174004873
Name:CRAIG, SANDRA MILENA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MILENA
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 WINTER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-3410
Mailing Address - Country:US
Mailing Address - Phone:817-372-1076
Mailing Address - Fax:
Practice Address - Street 1:3055 BARDIN RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:972-522-2200
Practice Address - Fax:972-522-2220
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2137601225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant