Provider Demographics
NPI:1649029836
Name:CRAIGIE, VICTORIA L (LMT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:L
Last Name:CRAIGIE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N BEN FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1506
Mailing Address - Country:US
Mailing Address - Phone:724-910-3694
Mailing Address - Fax:
Practice Address - Street 1:520 PHILADELPHIA ST STE 11
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3902
Practice Address - Country:US
Practice Address - Phone:724-910-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG009671225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist