Individual
MR. CRAIG ALLAN HAVERMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
202 10TH STREET SE, CEDAR RAPIDS, IA 52403-2404
(319) 398-1506
(319) 558-4062
Mailing address
PO BOX 3178, CEDAR RAPIDS, IA 52406-3178
(319) 398-1583
(319) 399-2085
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001279
IA
2255A2300X
Athletic Trainer
00156
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00156
IOWA LICENSE, ATC
IA
01
—
089702522
NATABOC #
IA
01
—
960644
NATA MEMBER #
IA
Enumeration date
07/15/2006
Last updated
09/11/2013
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