Provider Demographics
NPI:1083962773
Name:PERIOT, CRYSTAL ANN (DPT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:PERIOT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 166TH AVE NE
Mailing Address - Street 2:#A301
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3769
Mailing Address - Country:US
Mailing Address - Phone:425-941-1756
Mailing Address - Fax:
Practice Address - Street 1:8851 166TH AVE NE
Practice Address - Street 2:#A301
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3769
Practice Address - Country:US
Practice Address - Phone:425-941-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60051914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist