=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730588781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG MICHAELS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2014
-----------------------------------------------------
Last Update Date | 12/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 FOULK RD STE 2A
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-407-3422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 144 ROUTE 34 OLD BRIDGE SPINE & WELLNESS
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-316-5895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA01559900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------