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General NPI Number Information
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NPI Number | 1396296315
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Entity Type | Individual
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Provider Name | CASEY CRADDOCK LAT, MAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 1475 ENGINEERING DR
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City | MADISON
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State | WI
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Zip | 53706-1607
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Country | US
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Telephone | 608-440-0363
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 MORRISON ST
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City | MADISON
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State | WI
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Zip | 53703-3816
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Country | US
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Telephone | 970-518-9071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1912
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License Number State | WI
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