Provider Demographics
NPI:1871996389
Name:CRAIG, VICKEY SUE (PTA)
Entity type:Individual
Prefix:
First Name:VICKEY
Middle Name:SUE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:2010 SW H K DODGEN LOOP
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7062
Practice Address - Country:US
Practice Address - Phone:254-774-9991
Practice Address - Fax:254-774-9980
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2104600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant