Provider Demographics
NPI:1891055992
Name:CRAIG, BARRY T (LMP)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:T
Last Name:CRAIG
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23631 78TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8819
Mailing Address - Country:US
Mailing Address - Phone:425-774-1737
Mailing Address - Fax:
Practice Address - Street 1:23631 78TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8819
Practice Address - Country:US
Practice Address - Phone:425-774-1737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA118648OtherDEPARTMENT OF LABOR AND INDUSTRIES