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NPI Code Detail

MEDICARE: MR. CRAIG MARSHALL KRAGER ATC

MEDICARE: MR. CRAIG MARSHALL KRAGER ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1083839872
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CRAIG MARSHALL KRAGER ATC
Provider Business Mailing Address
First Line : 1315 E 18TH ST
Second Line :
City : LOVELAND
State : CO
Zip : 80538-4159
Country : US
Telephone Number : 970-744-0513
Fax Number :
Provider Business Practice Location Address
First Line : 1551 PROFESSIONAL LN UNIT 200
Second Line :
City : LONGMONT
State : CO
Zip : 80501-6964
Country : US
Telephone Number : 303-772-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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