Provider Demographics
NPI:1356961080
Name:CARNELL, CRAIG LEE (ATC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:LEE
Last Name:CARNELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:CARNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAT,ATC
Mailing Address - Street 1:3875 KAISER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-9325
Mailing Address - Country:US
Mailing Address - Phone:407-448-4276
Mailing Address - Fax:
Practice Address - Street 1:3875 KAISER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-9325
Practice Address - Country:US
Practice Address - Phone:407-448-4276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer