Provider Demographics
NPI:1780937789
Name:PFEIFER, CRAIG ELLIOTT (PHD, ATC, FHEA)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ELLIOTT
Last Name:PFEIFER
Suffix:
Gender:M
Credentials:PHD, ATC, FHEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3755 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:ST JAMES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33956-2205
Mailing Address - Country:US
Mailing Address - Phone:410-652-4166
Mailing Address - Fax:
Practice Address - Street 1:139 CREVALLE RD
Practice Address - Street 2:
Practice Address - City:ROTONDA WEST
Practice Address - State:FL
Practice Address - Zip Code:33947-2855
Practice Address - Country:US
Practice Address - Phone:410-652-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13272255A2300X
MDA00000782255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000002752OtherBOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER