Provider Demographics
NPI:1326778614
Name:CRAIG, BRANDON T (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:T
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 HIGHWAY 171 STE C
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-9434
Mailing Address - Country:US
Mailing Address - Phone:318-775-9870
Mailing Address - Fax:318-775-9884
Practice Address - Street 1:2070 HIGHWAY 171 STE C
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9434
Practice Address - Country:US
Practice Address - Phone:318-775-9870
Practice Address - Fax:318-775-9884
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist