Healthcare Provider Details

I. General information

NPI: 1487660437
Provider Name (Legal Business Name): CRAIG FRANK NEFFENDORF PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MAIN ST
BLANCO TX
78606-4900
US

IV. Provider business mailing address

11 MAIN ST
BLANCO TX
78606-4900
US

V. Phone/Fax

Practice location:
  • Phone: 830-833-3068
  • Fax: 830-833-3133
Mailing address:
  • Phone: 830-833-3068
  • Fax: 830-833-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1099380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: