Healthcare Provider Details

I. General information

NPI: 1881955979
Provider Name (Legal Business Name): JENNIFER RAE CRAFT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 GLEN ESTE WITHAMSVILLE RD SUITE 500
CINCINNATI OH
45245-1318
US

IV. Provider business mailing address

4440 GLEN ESTE WITHAMSVILLE RD SUITE 500
CINCINNATI OH
45245-1318
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-3630
  • Fax: 513-753-4308
Mailing address:
  • Phone: 513-943-3630
  • Fax: 513-753-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.012632
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.005504
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: