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General NPI Number Information
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NPI Number | 1548754294
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Entity Type | Individual
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Provider Name | BRENDA EARNER CRAIG MPT
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Gender | Female
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Dates
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Enumeration Date | 06/17/2018
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Last Update Date | 06/17/2018
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Provider Practice Location Address
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Address Line | 152 S MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4619
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Country | US
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Telephone | 757-738-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-5424
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Country | US
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Telephone | 252-573-8268
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305204794
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License Number State | VA
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