Provider Demographics
NPI:1871597427
Name:SQUIRE, CRAIG EDWARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDWARD
Last Name:SQUIRE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PINE WOODS RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1657
Mailing Address - Country:US
Mailing Address - Phone:845-229-6500
Mailing Address - Fax:845-229-6181
Practice Address - Street 1:58 PINE WOODS RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1657
Practice Address - Country:US
Practice Address - Phone:845-229-6500
Practice Address - Fax:845-229-6181
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020488-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL2931Medicare ID - Type Unspecified
QL2931Medicare UPIN