Provider Demographics
NPI:1588601850
Name:TEDDER, CRAIG M (DPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:TEDDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 CAPITOL WAY S
Mailing Address - Street 2:STE 300
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1212
Mailing Address - Country:US
Mailing Address - Phone:360-413-4200
Mailing Address - Fax:
Practice Address - Street 1:1118 VIEW AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1870
Practice Address - Country:US
Practice Address - Phone:360-736-5273
Practice Address - Fax:360-736-5053
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911745305-98501-A002OtherTRICARE
WA1013865Medicaid
WA462155OtherLABOR & INDUSTRIES
WA710883456-98512-A006OtherTRICARE
WA7883504OtherAETNA
WA3186TEOtherREGENCE BLUE SHIELD
WA710883456-98501-A007OtherTRICARE
WA7883504OtherAETNA
WA911745305-98501-A002OtherTRICARE
WA3186TEOtherREGENCE BLUE SHIELD
WA8905065OtherL&I CRIME VICTIMS