Healthcare Provider Details

I. General information

NPI: 1114912904
Provider Name (Legal Business Name): CRAIG PAUL MOORHOUSE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 11/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 SUNCREST DR
GRAY TN
37615-4118
US

IV. Provider business mailing address

220 ALFALFA LN
JONESBOROUGH TN
37659-3175
US

V. Phone/Fax

Practice location:
  • Phone: 423-477-1600
  • Fax:
Mailing address:
  • Phone: 423-202-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number394
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: