Provider Demographics
NPI:1417015678
Name:CRAGER, BRIAN (MS, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:CRAGER
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 WOODHILL ST NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-1959
Mailing Address - Country:US
Mailing Address - Phone:503-509-1473
Mailing Address - Fax:
Practice Address - Street 1:2225 WOODHILL ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-1959
Practice Address - Country:US
Practice Address - Phone:503-509-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670010592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer