Provider Demographics
NPI:1932155199
Name:CRITCHFIELD, CRAIG A (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:CRITCHFIELD
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2883
Mailing Address - Country:US
Mailing Address - Phone:407-708-2675
Mailing Address - Fax:407-708-2142
Practice Address - Street 1:100 WELDON BLVD
Practice Address - Street 2:ATHLETIC DEPARTMENT 56
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-6132
Practice Address - Country:US
Practice Address - Phone:407-708-2675
Practice Address - Fax:407-708-2142
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL-15892255A2300X
PART0031872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer