Provider Demographics
NPI:1942248596
Name:HAMANN, CRAIG L (DPT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:L
Last Name:HAMANN
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 1:215 N WHITLEY DR
Mailing Address - Street 2:STE 1
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2706
Mailing Address - Country:US
Mailing Address - Phone:208-452-6366
Mailing Address - Fax:208-452-6399
Practice Address - Street 1:215 N WHITLEY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2705
Practice Address - Country:US
Practice Address - Phone:208-452-6366
Practice Address - Fax:208-452-6399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist