Provider Demographics
NPI:1528339686
Name:CRAIG, RONDA CONNIE (PTA1471)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:CONNIE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PTA1471
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 PANTHER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5628
Mailing Address - Country:US
Mailing Address - Phone:850-284-2644
Mailing Address - Fax:
Practice Address - Street 1:2584 PANTHER CREEK RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5628
Practice Address - Country:US
Practice Address - Phone:850-284-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1471225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant