Provider Demographics
NPI:1306246590
Name:CRAVEN, MATTHEW STUART (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STUART
Last Name:CRAVEN
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 EIGHT BELLES LN
Mailing Address - Street 2:APT 3H
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9879
Mailing Address - Country:US
Mailing Address - Phone:336-707-1492
Mailing Address - Fax:
Practice Address - Street 1:4009 EIGHT BELLES LN
Practice Address - Street 2:APT 3H
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9879
Practice Address - Country:US
Practice Address - Phone:336-707-1492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer