Provider Demographics
NPI:1376610550
Name:PAHL, CRAIG HARVEY (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:HARVEY
Last Name:PAHL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:H
Other - Last Name:PAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8267 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7717
Mailing Address - Country:US
Mailing Address - Phone:305-665-7848
Mailing Address - Fax:305-665-7851
Practice Address - Street 1:8267 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7717
Practice Address - Country:US
Practice Address - Phone:305-665-7848
Practice Address - Fax:305-665-7851
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2228ZMedicare ID - Type Unspecified