Provider Demographics
NPI:1023072345
Name:DENEGAR, CRAIG R (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:DENEGAR
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:PHYSICAL THERAPY
Mailing Address - Street 2:358 MANSFIELD ROAD, UNIT 2101
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-2101
Mailing Address - Country:US
Mailing Address - Phone:860-486-0052
Mailing Address - Fax:860-486-1158
Practice Address - Street 1:PHYSICAL THERAPY
Practice Address - Street 2:358 MANSFIELD ROAD, UNIT 2101
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-2101
Practice Address - Country:US
Practice Address - Phone:860-486-0052
Practice Address - Fax:860-486-1158
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007701L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017957400001Medicaid
036376Medicare ID - Type Unspecified
PA0017957400001Medicaid