MEDICARE: AARON CRAIK LMT

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	225700000X	Massage Therapist	MA60849063	WA

General Provider Information

NPI Number	:	1417420324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON CRAIK LMT

Provider Business Mailing Address
First Line	:	PO BOX 443
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-0443
Country	:	US
Telephone Number	:	509-301-2426
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 N COLLEGE AVE UNIT 2
Second Line	:
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1048
Country	:	US
Telephone Number	:	509-301-2426
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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