Provider Demographics
NPI:1811018633
Name:CRAIG, LISA (ATC, LAT , LMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:ATC, LAT , LMT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:TOMKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC,LAT, LMT
Mailing Address - Street 1:4101 MEXICO RD STE H
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-6414
Mailing Address - Country:US
Mailing Address - Phone:636-947-4513
Mailing Address - Fax:
Practice Address - Street 1:4101 MEXICO RD STE H
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6414
Practice Address - Country:US
Practice Address - Phone:314-267-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1148282255A2300X
MO2001009355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer