Healthcare Provider Details

I. General information

NPI: 1649023482
Provider Name (Legal Business Name): CRAIG DWELLING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 10/15/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 S FIGUEROA ST APT 939
LOS ANGELES CA
90012-2563
US

IV. Provider business mailing address

234 S FIGUEROA ST APT 939
LOS ANGELES CA
90012-2563
US

V. Phone/Fax

Practice location:
  • Phone: 347-616-5249
  • Fax:
Mailing address:
  • Phone: 347-616-5249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: