Provider Demographics
NPI:1215158530
Name:CRALLE PHYSICAL THERAPY SERVICES, PA
Entity type:Organization
Organization Name:CRALLE PHYSICAL THERAPY SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRALLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:561-276-9643
Mailing Address - Street 1:525 NE 3RD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33444-3800
Mailing Address - Country:US
Mailing Address - Phone:561-276-9643
Mailing Address - Fax:561-276-9198
Practice Address - Street 1:525 NE 3RD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3800
Practice Address - Country:US
Practice Address - Phone:561-276-9643
Practice Address - Fax:561-276-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT1043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5464Medicare ID - Type Unspecified