Provider Demographics
NPI:1952341729
Name:PREWITT, CRAIG ARTHUR (MPT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ARTHUR
Last Name:PREWITT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 S 23RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1602
Mailing Address - Country:US
Mailing Address - Phone:253-459-6960
Mailing Address - Fax:253-459-6980
Practice Address - Street 1:3209 S 23RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1602
Practice Address - Country:US
Practice Address - Phone:253-459-6960
Practice Address - Fax:253-459-6980
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA117032OtherLABOR & INDUSTRIES
WA8346991Medicaid
WA8930582OtherL&I CRIME VICTIMS PROGRAM
WAPR4515OtherREGENCE BLUESHIELD
WAAB21104Medicare ID - Type Unspecified
WA8346991Medicaid