Provider Demographics
NPI:1407111966
Name:WELLMAN, CRAIG DAVID (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:DAVID
Last Name:WELLMAN
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 1:5017 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1641
Mailing Address - Country:US
Mailing Address - Phone:614-819-1000
Mailing Address - Fax:614-819-1001
Practice Address - Street 1:5017 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1641
Practice Address - Country:US
Practice Address - Phone:614-819-1000
Practice Address - Fax:614-819-1001
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist