Provider Demographics
NPI:1104047380
Name:CULBRETH, DONALD CRAIG (PT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CRAIG
Last Name:CULBRETH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LAKEN LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3453
Mailing Address - Country:US
Mailing Address - Phone:407-523-8666
Mailing Address - Fax:
Practice Address - Street 1:330 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1318
Practice Address - Country:US
Practice Address - Phone:407-302-8067
Practice Address - Fax:407-302-8068
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist