Provider Demographics
NPI:1972756542
Name:CRAVEN, CAROL INEZ (PTA)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:INEZ
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 JONATHAN WAY N
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9038
Mailing Address - Country:US
Mailing Address - Phone:717-246-1606
Mailing Address - Fax:
Practice Address - Street 1:100 W QUEEN ST
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-2133
Practice Address - Country:US
Practice Address - Phone:717-246-1671
Practice Address - Fax:717-246-2405
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000847L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant