Provider Demographics
NPI:1154474849
Name:CRIVELLO, ANGELA J (DPT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:J
Last Name:CRIVELLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-507-0733
Mailing Address - Fax:425-283-5551
Practice Address - Street 1:3101 NORTHUP WAY STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1469
Practice Address - Country:US
Practice Address - Phone:425-462-5006
Practice Address - Fax:425-462-5019
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2107200Medicaid