Provider Demographics
NPI:1497948798
Name:TWEEDY, CRAIG (ATC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:TWEEDY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 17TH ST
Mailing Address - Street 2:MEMORIAL STADIUM
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1590
Mailing Address - Country:US
Mailing Address - Phone:815-855-7920
Mailing Address - Fax:812-856-1601
Practice Address - Street 1:1001 E 17TH ST
Practice Address - Street 2:MEMORIAL STADIUM
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1590
Practice Address - Country:US
Practice Address - Phone:815-855-7920
Practice Address - Fax:812-856-1601
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002063A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer