MEDICARE: CRAIG PIAZZA PT

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	PT19791	FL

General Provider Information

NPI Number	:	1700832631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG PIAZZA PT

Provider Business Mailing Address
First Line	:	1135 NW 111TH AVE
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-7826
Country	:	US
Telephone Number	:	954-473-9802
Fax Number	:

Provider Business Practice Location Address
First Line	:	7175 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1050
Country	:	US
Telephone Number	:	954-572-0777
Fax Number	:	954-572-0551

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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