Healthcare Provider Details

I. General information

NPI: 1578356465
Provider Name (Legal Business Name): JOSEPH JAMES CRAFT JR. LMT, BCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 SWIFT CURRENT LOOP
BLYTHEWOOD SC
29016-9273
US

IV. Provider business mailing address

472 SWIFT CURRENT LOOP
BLYTHEWOOD SC
29016-9273
US

V. Phone/Fax

Practice location:
  • Phone: 401-450-2379
  • Fax:
Mailing address:
  • Phone: 401-450-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13715
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: