MEDICARE: MR. RAYMOND H. CRALLE RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT1043	FL

General Provider Information

NPI Number	:	1215930508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND H. CRALLE RPT

Provider Business Mailing Address
First Line	:	525 NE 3RD AVE
Second Line	:	STE 106
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3800
Country	:	US
Telephone Number	:	561-276-9643
Fax Number	:	561-276-9198

Provider Business Practice Location Address
First Line	:	525 NE 3RD AVE
Second Line	:	STE 106
City	:	DELRAY BEACH
State	:	FL
Zip	:	33444-3800
Country	:	US
Telephone Number	:	561-276-9643
Fax Number	:	561-276-9198

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. RAYMOND H. CRALLE RPT” Practice Location

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