Provider Demographics
NPI:1902952120
Name:CRAIG PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:CRAIG PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SADVAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS
Authorized Official - Phone:970-826-1552
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81626-1398
Mailing Address - Country:US
Mailing Address - Phone:970-826-1552
Mailing Address - Fax:970-826-1553
Practice Address - Street 1:360 E VICTORY WAY STE B
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-1824
Practice Address - Country:US
Practice Address - Phone:970-826-1552
Practice Address - Fax:970-826-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC496018Medicare PIN