Provider Demographics
NPI:1922434695
Name:BUNING, CRAIG JAY (DPT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JAY
Last Name:BUNING
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 E PARK ST
Mailing Address - Street 2:PO BOX 22
Mailing Address - City:FALMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:49632-5102
Mailing Address - Country:US
Mailing Address - Phone:231-878-6363
Mailing Address - Fax:
Practice Address - Street 1:2515 WHITE BEAR AVE N
Practice Address - Street 2:SUITE A11
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5155
Practice Address - Country:US
Practice Address - Phone:651-229-5466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60416104225100000X
MN10487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0318779OtherL & I
WA0318815OtherL & I
WA0318818OtherL & I
WA0318810OtherL & I
WAG8924695Medicare PIN
WA0318815OtherL & I
WAG8924693Medicare PIN
WAG8924688Medicare PIN
WAG8924687Medicare PIN