Provider Demographics
NPI:1225010457
Name:BUELL, CRAIG S (MPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:S
Last Name:BUELL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:BUELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:2700 GREENUP AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1953
Mailing Address - Country:US
Mailing Address - Phone:606-324-0540
Mailing Address - Fax:606-324-0616
Practice Address - Street 1:2700 GREENUP AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1953
Practice Address - Country:US
Practice Address - Phone:800-609-0905
Practice Address - Fax:800-609-0801
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002033225100000X
OHPT10426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2392110Medicaid
WV7301138000Medicaid
OH2392110Medicaid
WV650024567Medicare PIN
OHBU4252881Medicare PIN
ND4092592Medicare PIN
WV4092591Medicare PIN
WV7301138000Medicaid