MEDICARE: MRS. TRISHA LYNN CRAVENS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	03419	OH

General Provider Information

NPI Number	:	1982834172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRISHA LYNN CRAVENS PTA

Provider Business Mailing Address
First Line	:	7027 EDENTON PLEASANT PLAIN RD
Second Line	:
City	:	PLEASANT PLAIN
State	:	OH
Zip	:	45162-9370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5640 COX SMITH RD
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-2210
Country	:	US
Telephone Number	:	513-336-5289
Fax Number	:	513-336-7308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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