Provider Demographics
NPI:1184974115
Name:KURTZ, CRAIG R (PTA)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:KURTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:R
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASSOCIATES DEGREE
Mailing Address - Street 1:722 W. BECK LANE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023
Mailing Address - Country:US
Mailing Address - Phone:602-206-0548
Mailing Address - Fax:
Practice Address - Street 1:722 W. BECK LANE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023
Practice Address - Country:US
Practice Address - Phone:602-206-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9930A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant