Provider Demographics
NPI:1629685573
Name:GUSTAFSON, CRAIG ROBERT
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ROBERT
Last Name:GUSTAFSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16400 FRENCHTOWN FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-9301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16400 FRENCHTOWN FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834-9301
Practice Address - Country:US
Practice Address - Phone:406-626-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist