Provider Demographics
NPI:1619491545
Name:HOWARD, CRAIG (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54163
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39288-4163
Mailing Address - Country:US
Mailing Address - Phone:601-487-6814
Mailing Address - Fax:601-487-6815
Practice Address - Street 1:2509 OLD BRANDON RD STE C
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4610
Practice Address - Country:US
Practice Address - Phone:601-487-6814
Practice Address - Fax:601-487-6815
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist