Provider Demographics
NPI:1508085416
Name:BRANNAN, CRAIG MARTIN (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MARTIN
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 JEFF HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-8009
Mailing Address - Country:US
Mailing Address - Phone:251-510-0480
Mailing Address - Fax:
Practice Address - Street 1:820 UNIVERSITY BLVD S STE 3E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7861
Practice Address - Country:US
Practice Address - Phone:251-343-0985
Practice Address - Fax:251-343-2713
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist