Provider Demographics
NPI:1891972204
Name:CRIBBS, CHARLES MORRIS II
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:MORRIS
Last Name:CRIBBS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:MORRIS
Other - Last Name:CRIBBS
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:14956 SE 140TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:WEIRSDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32195-2203
Mailing Address - Country:US
Mailing Address - Phone:352-615-6801
Mailing Address - Fax:
Practice Address - Street 1:14956 SE 140TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:WEIRSDALE
Practice Address - State:FL
Practice Address - Zip Code:32195-2203
Practice Address - Country:US
Practice Address - Phone:352-615-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist