Provider Demographics
NPI:1467633636
Name:CRAIGEN, EMILY M (DPT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:M
Last Name:CRAIGEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:HULS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:530 ROCKLAND RD
Mailing Address - Street 2:STE 500
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4137
Mailing Address - Country:US
Mailing Address - Phone:815-893-8480
Mailing Address - Fax:815-893-8481
Practice Address - Street 1:530 ROCKLAND RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4131
Practice Address - Country:US
Practice Address - Phone:815-893-8480
Practice Address - Fax:815-893-8481
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK47411OtherMEDICARE
ILP01060236OtherRAILROAD MEDICARE
ILK47410OtherMEDICARE
ILIL6237012OtherMEDICARE
ILIL6238012OtherMEDICARE
ILIL6697014OtherMEDICARE