Individual
CRAIG M TEDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1118 VIEW AVE, CENTRALIA, WA 98531-1870
(360) 736-5273
(360) 736-5053
Mailing address
1018 CAPITOL WAY S, STE 300, OLYMPIA, WA 98501-1212
(360) 413-4200
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00009225
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013865
—
WA
01
—
3186TE
REGENCE BLUE SHIELD
WA
01
—
462155
LABOR & INDUSTRIES
WA
01
—
710883456-98501-A007
TRICARE
WA
01
—
710883456-98512-A006
TRICARE
WA
01
—
7883504
AETNA
WA
01
—
911745305-98501-A002
TRICARE
WA
Enumeration date
06/02/2006
Last updated
07/10/2023
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