Provider Demographics
NPI:1972892628
Name:MORIWAKI, CRAIG (AT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MORIWAKI
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 N EAGLE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-0998
Mailing Address - Country:US
Mailing Address - Phone:208-938-3334
Mailing Address - Fax:208-938-3335
Practice Address - Street 1:5418 N EAGLE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0998
Practice Address - Country:US
Practice Address - Phone:208-938-3334
Practice Address - Fax:208-938-3335
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT3222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer