Provider Demographics
NPI:1295123008
Name:CALDWELL, CRAIG THOMAS (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:THOMAS
Last Name:CALDWELL
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 1:245 N COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4230
Mailing Address - Country:US
Mailing Address - Phone:337-232-5301
Mailing Address - Fax:337-237-6504
Practice Address - Street 1:245 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4230
Practice Address - Country:US
Practice Address - Phone:337-232-5301
Practice Address - Fax:337-237-6504
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist