Provider Demographics
NPI:1326063405
Name:MADDEN, CRAIG A (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:MADDEN
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 1:23010 NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-3264
Mailing Address - Country:US
Mailing Address - Phone:216-289-6307
Mailing Address - Fax:
Practice Address - Street 1:35000 KAISER CT
Practice Address - Street 2:SUITE 301
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3382
Practice Address - Country:US
Practice Address - Phone:440-951-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600313Medicaid
OHMA4159522Medicare ID - Type UnspecifiedSHAKER
OHMA4159521Medicare ID - Type UnspecifiedWILLOUGHBY
OH2600313Medicaid