Provider Demographics
NPI:1093420630
Name:CRESCENDO THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:CRESCENDO THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:STUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-955-3390
Mailing Address - Street 1:1413 CAMPOSTELLA RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6003
Mailing Address - Country:US
Mailing Address - Phone:757-955-3390
Mailing Address - Fax:
Practice Address - Street 1:3626 WESTERN BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2534
Practice Address - Country:US
Practice Address - Phone:757-955-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist AssistantGroup - Single Specialty