Provider Demographics
NPI:1538191648
Name:CRAIN, TOM (PT)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:
Last Name:CRAIN
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 1:1000 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078
Mailing Address - Country:US
Mailing Address - Phone:334-283-8032
Mailing Address - Fax:334-283-1136
Practice Address - Street 1:1000 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078
Practice Address - Country:US
Practice Address - Phone:334-283-8032
Practice Address - Fax:334-283-1136
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL45311OtherHEALTHSPRING OF AL
AL1054269OtherFIRST HEALTH
AL51076140OtherBLUE CROSS BLUE SHIELD
1487373OtherCIGNA
AL6410033OtherUNITED HEALTHCARE
682573OtherACN GROUP
AL7134065OtherAETNA
S18036Medicare UPIN