Healthcare Provider Details

I. General information

NPI: 1780937789
Provider Name (Legal Business Name): CRAIG ELLIOTT PFEIFER PHD, ATC, FHEA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CREVALLE RD
ROTONDA WEST FL
33947-2855
US

IV. Provider business mailing address

3755 EMERALD AVE
ST JAMES CITY FL
33956-2205
US

V. Phone/Fax

Practice location:
  • Phone: 410-652-4166
  • Fax:
Mailing address:
  • Phone: 410-652-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1327
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000078
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: