Provider Demographics
NPI:1104092881
Name:CRAIGO, JOHN ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALAN
Last Name:CRAIGO
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 1:7230 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7522
Mailing Address - Country:US
Mailing Address - Phone:440-946-5858
Mailing Address - Fax:440-918-4870
Practice Address - Street 1:7230 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7522
Practice Address - Country:US
Practice Address - Phone:440-946-5858
Practice Address - Fax:440-918-4870
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1979225100000X
OHPT7994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist