Provider Demographics
NPI:1891772703
Name:TAFT, CRAIG E (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
Last Name:TAFT
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 1:4701 S 19TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1199
Mailing Address - Country:US
Mailing Address - Phone:253-759-1310
Mailing Address - Fax:253-759-1330
Practice Address - Street 1:4701 S 19TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1199
Practice Address - Country:US
Practice Address - Phone:253-759-1310
Practice Address - Fax:253-759-1330
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA718656Medicaid
WA718656Medicaid