Provider Demographics
NPI:1316044647
Name:STASIO, CRAIG EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDWARD
Last Name:STASIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8516 HOMESTEAD DR STE 107
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9226
Mailing Address - Country:US
Mailing Address - Phone:616-741-9555
Mailing Address - Fax:616-741-9559
Practice Address - Street 1:8516 HOMESTEAD DR STE 107
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-9226
Practice Address - Country:US
Practice Address - Phone:616-741-9555
Practice Address - Fax:616-741-9559
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN95540008Medicare ID - Type Unspecified
MICS012065Medicare UPIN