Provider Demographics
NPI:1982017612
Name:CRAIG, PAUL C (DPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:CRAIG
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 1:6820 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1412
Mailing Address - Country:US
Mailing Address - Phone:402-770-5496
Mailing Address - Fax:913-681-9906
Practice Address - Street 1:2320 N 6TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-1214
Practice Address - Country:US
Practice Address - Phone:402-228-9292
Practice Address - Fax:402-228-9191
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist