Provider Demographics
NPI:1821263864
Name:MCBRIDE, CRAIG R (PT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:R
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2500 KEMP BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-5347
Mailing Address - Country:US
Mailing Address - Phone:940-687-3422
Mailing Address - Fax:940-687-0726
Practice Address - Street 1:1320 NW HOMESTEAD DR
Practice Address - Street 2:STE E
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5243
Practice Address - Country:US
Practice Address - Phone:580-353-6300
Practice Address - Fax:580-353-6319
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2099225100000X
TX1101186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist