Provider Demographics
NPI:1417301946
Name:CRAFT, DERIK ROBERT
Entity Type:Individual
Prefix:
First Name:DERIK
Middle Name:ROBERT
Last Name:CRAFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 57TH STREET
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105
Mailing Address - Country:US
Mailing Address - Phone:304-481-7887
Mailing Address - Fax:
Practice Address - Street 1:509 PEACH ST APT 5
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1130
Practice Address - Country:US
Practice Address - Phone:304-481-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer