Healthcare Provider Details

I. General information

NPI: 1447371257
Provider Name (Legal Business Name): EDMUND GRAHAM CRTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NW 184TH DR
MIAMI FL
33169-4268
US

IV. Provider business mailing address

820 NW 184TH DR
MIAMI FL
33169-4268
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-7501
  • Fax:
Mailing address:
  • Phone: 305-654-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT 10959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: