Provider Demographics
NPI:1801024237
Name:DYE, CRAIG JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:JOSEPH
Last Name:DYE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1320
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:151 ECO FRIENDLY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-5060
Practice Address - Country:US
Practice Address - Phone:918-608-1135
Practice Address - Fax:918-608-1142
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5987225100000X
OK5213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ352248783Medicare PIN