Provider Demographics
NPI:1700264421
Name:WASHINGTON, CRAIG STEPHEN (EDD, LMT, MMP)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEPHEN
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:EDD, LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SPRING MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-2673
Mailing Address - Country:US
Mailing Address - Phone:312-399-4967
Mailing Address - Fax:
Practice Address - Street 1:807 SPRING MILLS RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-2673
Practice Address - Country:US
Practice Address - Phone:312-399-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT115309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT115309OtherMT115309