Healthcare Provider Details

I. General information

NPI: 1619557816
Provider Name (Legal Business Name): THOMAS JAY CRAVENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 GRANT AVE STE 100
LOVELAND CO
80538-8433
US

IV. Provider business mailing address

PO BOX 866308
PLANO TX
75086-6308
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-7780
  • Fax:
Mailing address:
  • Phone: 469-609-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0017581
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: