Provider Demographics
NPI:1497883581
Name:CRANER, GARY (LAT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:CRANER
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 UNIVERSITY DR
Mailing Address - Street 2:MS 1020
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83725-0002
Mailing Address - Country:US
Mailing Address - Phone:208-426-1696
Mailing Address - Fax:
Practice Address - Street 1:10360 W ALLIANCE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-3963
Practice Address - Country:US
Practice Address - Phone:208-859-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-0062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer