Provider Demographics
NPI:1376685784
Name:CRAIG, SHAWN E (PT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:E
Last Name:CRAIG
Suffix:
Gender:F
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:PO BOX 1566
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-1566
Mailing Address - Country:US
Mailing Address - Phone:423-622-2402
Mailing Address - Fax:423-622-8778
Practice Address - Street 1:503 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5028
Practice Address - Country:US
Practice Address - Phone:423-622-2402
Practice Address - Fax:423-622-8778
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000002652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3653476Medicare ID - Type Unspecified