MEDICARE: DAIRON MARTIN CREACH M.A.

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	261QP2000X	Physical Therapy Clinic/Center	HCC9849	FL

General Provider Information

NPI Number	:	1245504968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAIRON MARTIN CREACH M.A.

Provider Business Mailing Address
First Line	:	4999 W 8TH AVE STE 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-698-2296
Fax Number	:

Provider Business Practice Location Address
First Line	:	4999 W 8TH AVE STE 1
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-698-2296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/07/2013

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