Most Relevant Information
Provider Data
| NPI Number: | 1003225392 |
| Provider Name: | CRAIG DISS PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 06004292A |
Most Important Dates
| Enumeration Date: | 08/12/2014 |
| Last Updated: | 08/12/2014 |
Provider Practice Location
2625 CREEPING PHLOX CV
FORT WAYNE
IN
468188942
Practice Location Phone/Fax
| Phone: | 2604504828 |
| Fax: |
Provider Mailing Location
2625 CREEPING PHLOX CV
FORT WAYNE
IN
468188942
Provider Mailing Phone/Fax
| Phone: | 2604504828 |
| Fax: |