Provider Demographics
NPI:1649425851
Name:CRAIG, SUE C (PTA)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:C
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79403-1010
Mailing Address - Country:US
Mailing Address - Phone:806-928-5771
Mailing Address - Fax:
Practice Address - Street 1:208 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403-1010
Practice Address - Country:US
Practice Address - Phone:806-928-5771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2009163225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant