Provider Demographics
NPI:1427654599
Name:CRAGHEAD, ROBIN LYNN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:CRAGHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 SW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3624
Mailing Address - Country:US
Mailing Address - Phone:801-502-1376
Mailing Address - Fax:
Practice Address - Street 1:1042 SW 11TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3624
Practice Address - Country:US
Practice Address - Phone:801-502-1376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL77077225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist