Provider Demographics
NPI:1982027363
Name:LONG, CRAIG (PTA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1550 OCHSNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8192
Mailing Address - Country:US
Mailing Address - Phone:985-893-4700
Mailing Address - Fax:985-893-3211
Practice Address - Street 1:7520 WESTBANK EXPY
Practice Address - Street 2:SUITE D
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2354
Practice Address - Country:US
Practice Address - Phone:504-371-4226
Practice Address - Fax:504-371-4228
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant