MEDICARE: PROF. JOSEPH (JOE) DAVID CRACRAFT PT, PH.D.

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
1	174400000X	Specialist	0658	NV

General Provider Information

NPI Number	:	1396961611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JOSEPH (JOE) DAVID CRACRAFT PT, PH.D.

Provider Business Mailing Address
First Line	:	7433 ALICE SPRINGS CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5919
Country	:	US
Telephone Number	:	702-651-5588
Fax Number	:	702-651-5506

Provider Business Practice Location Address
First Line	:	6375 WEST CHARLESTON BLVD.
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89143
Country	:	US
Telephone Number	:	702-651-5588
Fax Number	:	720-651-5506

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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