Provider Demographics
NPI:1497428684
Name:CRESPO, DAVID JR (PTA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CRESPO
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17267 NW 60TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4664
Mailing Address - Country:US
Mailing Address - Phone:786-395-4955
Mailing Address - Fax:
Practice Address - Street 1:5850 S PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5933
Practice Address - Country:US
Practice Address - Phone:954-800-5826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30857225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant