Provider Demographics
NPI:1235389479
Name:BIRAO, MARICRYST (PT)
Entity Type:Individual
Prefix:
First Name:MARICRYST
Middle Name:
Last Name:BIRAO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37197 E STONEY RUN
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-4325
Mailing Address - Country:US
Mailing Address - Phone:302-524-8333
Mailing Address - Fax:
Practice Address - Street 1:6 ELLIS ALLEY UNIT 6
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3607
Practice Address - Country:US
Practice Address - Phone:302-524-8333
Practice Address - Fax:302-524-8891
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34184225100000X
DEJ1-002458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist