Healthcare Provider Details

I. General information

NPI: 1306981576
Provider Name (Legal Business Name): BETH ANN CRAIG ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MUNDIS MILL RD
YORK PA
17402-9714
US

IV. Provider business mailing address

700 WILLOW RIDGE DR
YORK PA
17404-6604
US

V. Phone/Fax

Practice location:
  • Phone: 717-846-6789
  • Fax:
Mailing address:
  • Phone: 717-767-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001520A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: