Provider Demographics
NPI:1871691006
Name:STEPHENS, CRAIG L (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9631 N. NEVADA
Mailing Address - Street 2:STE LL2
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218
Mailing Address - Country:US
Mailing Address - Phone:509-483-0889
Mailing Address - Fax:509-483-0974
Practice Address - Street 1:9631 N. NEVADA
Practice Address - Street 2:STE LL2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218
Practice Address - Country:US
Practice Address - Phone:509-483-0889
Practice Address - Fax:509-483-0974
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7035009Medicaid
WAS35181Medicare UPIN
WA7035009Medicaid