Provider Demographics
NPI:1568025930
Name:COMBS, CRAIG (PTA, CCI)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:COMBS
Suffix:
Gender:M
Credentials:PTA, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3165
Mailing Address - Country:US
Mailing Address - Phone:903-312-9548
Mailing Address - Fax:
Practice Address - Street 1:615 COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3165
Practice Address - Country:US
Practice Address - Phone:903-312-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2116880225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant