MEDICARE: CRALLE PHYSICAL THERAPY SERVICES, PA

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	:	1215158530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRALLE PHYSICAL THERAPY SERVICES, PA

Provider Business Mailing Address
First Line	:	525 NE 3RD AVE
Second Line	:	SUITE 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	:	SUITE 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	:	PRESIDENT
Name	:	RAYMOND H CRALLE
Credential	:	RPT
Telephone Number	:	561-276-9643

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	10/10/2012

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