Provider Demographics
NPI:1093856569
Name:CREVISTON, VALERIE (DPT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:CREVISTON
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 1:101 E PLUMMER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8047
Mailing Address - Country:US
Mailing Address - Phone:217-483-8171
Mailing Address - Fax:217-483-8173
Practice Address - Street 1:101 E PLUMMER BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8047
Practice Address - Country:US
Practice Address - Phone:214-483-8171
Practice Address - Fax:217-483-8173
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist