Provider Demographics
NPI:1487660437
Name:NEFFENDORF, CRAIG FRANK (PT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:FRANK
Last Name:NEFFENDORF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-4900
Mailing Address - Country:US
Mailing Address - Phone:830-833-3068
Mailing Address - Fax:830-833-3133
Practice Address - Street 1:11 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-4900
Practice Address - Country:US
Practice Address - Phone:830-833-3068
Practice Address - Fax:830-833-3133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184047201Medicaid
TX659911OtherBCBS
TX612596Medicare PIN