Provider Demographics
NPI:1770994212
Name:CRAGG, STEPHANIE MARIE (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:CRAGG
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3407
Mailing Address - Country:US
Mailing Address - Phone:352-817-2512
Mailing Address - Fax:833-525-1863
Practice Address - Street 1:917 GRANT AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3407
Practice Address - Country:US
Practice Address - Phone:352-817-2512
Practice Address - Fax:833-525-1863
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR621892251X0800X
TN9932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic