MEDICARE: MR. CRAIG ALLEN DEVINE P.T., A.T.C.

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	225100000X	Physical Therapist	PT-07472	OH

General Provider Information

NPI Number	:	1902934284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG ALLEN DEVINE P.T., A.T.C.

Provider Business Mailing Address
First Line	:	1550 VALLEY DR
Second Line	:
City	:	MARYSVILLE
State	:	OH
Zip	:	43040-9198
Country	:	US
Telephone Number	:	937-644-3931
Fax Number	:	614-273-5636

Provider Business Practice Location Address
First Line	:	4605 SAWMILL RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2246
Country	:	US
Telephone Number	:	614-273-5633
Fax Number	:	614-273-5636

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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