Provider Demographics
NPI:1619228921
Name:CRAIG, AMY BETH (PT)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:BETH
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CLINE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2579
Mailing Address - Country:US
Mailing Address - Phone:219-865-9203
Mailing Address - Fax:219-865-9253
Practice Address - Street 1:2300 CLINE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2579
Practice Address - Country:US
Practice Address - Phone:219-865-9203
Practice Address - Fax:219-865-9253
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.008167225100000X
IN05011285A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist