Healthcare Provider Details

I. General information

NPI: 1538280391
Provider Name (Legal Business Name): CRAIG COHEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

IV. Provider business mailing address

2142 NE 123RD ST
NORTH MIAMI FL
33181-2902
US

V. Phone/Fax

Practice location:
  • Phone: 305-967-8976
  • Fax: 305-967-8863
Mailing address:
  • Phone: 305-967-8976
  • Fax: 305-967-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT17945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: