Provider Demographics
NPI:1306946389
Name:CRAIG, RANDALL LEWIS (PT ATC)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:LEWIS
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
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Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:134 CHESTERFIELD VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1161
Practice Address - Country:US
Practice Address - Phone:636-812-0094
Practice Address - Fax:636-812-0152
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR1130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000025171Medicare ID - Type Unspecified