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General NPI Number Information
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NPI Number | 1811645633
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Entity Type | Individual
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Provider Name | CRAIG SHORT DPT
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Gender | Male
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 480 WOLVERINE DR STE 5
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City | BAYFIELD
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State | CO
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Zip | 81122-9653
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Country | US
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Telephone | 970-884-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 506 COUNTY ROAD 215
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City | DURANGO
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State | CO
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Zip | 81303-7841
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Country | US
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Telephone | 970-317-4959
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.0018224
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License Number State | CO
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