Provider Demographics
NPI:1528119633
Name:ULLOCK, CRAIG CLARKE (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:CLARKE
Last Name:ULLOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 THOMAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480
Mailing Address - Country:US
Mailing Address - Phone:585-346-0060
Mailing Address - Fax:585-346-0108
Practice Address - Street 1:66 STANLEY ST
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1435
Practice Address - Country:US
Practice Address - Phone:585-658-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017728225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist