Provider Demographics
NPI:1477843829
Name:CRAIG, ANGELA C
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1945
Mailing Address - Country:US
Mailing Address - Phone:724-816-4482
Mailing Address - Fax:
Practice Address - Street 1:327 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-1945
Practice Address - Country:US
Practice Address - Phone:724-816-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021132225100000X
FL31568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31568OtherPHYSICAL THERAPY LICENSE