Healthcare Provider Details

I. General information

NPI: 1659710978
Provider Name (Legal Business Name): CRAIG R HADFIELD PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N. FALER AVE
PINEDALE WY
82941
US

IV. Provider business mailing address

PO BOX 1037
PINEDALE WY
82941-1037
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-6236
  • Fax: 307-367-3332
Mailing address:
  • Phone: 307-367-6236
  • Fax: 307-367-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2841
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8602203-2401
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10995
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: