Provider Demographics
NPI:1669067922
Name:CRAIG, JOHANNA THERESE (LAC DIPL)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:THERESE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LAC DIPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-2111
Mailing Address - Country:US
Mailing Address - Phone:215-913-0723
Mailing Address - Fax:
Practice Address - Street 1:131 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012-2111
Practice Address - Country:US
Practice Address - Phone:215-913-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001336171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist