Provider Demographics
NPI:1821294281
Name:CRAFT, BETH M (PT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:M
Last Name:CRAFT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
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 1:1110 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8952
Practice Address - Country:US
Practice Address - Phone:662-862-4104
Practice Address - Fax:662-862-4162
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00721227Medicaid
MS00721227Medicaid