Provider Demographics
NPI:1669860920
Name:CRAIG, SHANNON M (DPT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5347 CAREFREE CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4718
Mailing Address - Country:US
Mailing Address - Phone:513-257-1984
Mailing Address - Fax:
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-8005
Practice Address - Country:US
Practice Address - Phone:937-806-0318
Practice Address - Fax:937-806-0319
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH015149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist