Provider Demographics
NPI:1790721363
Name:CRAIN, JUSTIN B (RPT)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:B
Last Name:CRAIN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1265
Mailing Address - Country:US
Mailing Address - Phone:334-283-8032
Mailing Address - Fax:334-283-1136
Practice Address - Street 1:1000 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1265
Practice Address - Country:US
Practice Address - Phone:334-283-8032
Practice Address - Fax:334-283-1136
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531618OtherBLUE CROSS BLUE SHIELD
ALQ57152OtherUPIN
11507998OtherCAQH
AL7981728OtherAETNA