Provider Demographics
NPI:1821312315
Name:COX, CRAIG (PT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:COX
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 1:511 NE 21ST CT
Mailing Address - Street 2:#417
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2170
Mailing Address - Country:US
Mailing Address - Phone:954-604-7290
Mailing Address - Fax:
Practice Address - Street 1:511 NE 21ST CT
Practice Address - Street 2:#417
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2170
Practice Address - Country:US
Practice Address - Phone:954-604-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225100000XMedicare PIN
FL225100000XMedicare UPIN