Provider Demographics
NPI:1245743780
Name:GRICAR, CRISTAL N (DPT)
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:N
Last Name:GRICAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CRISTAL
Other - Middle Name:N
Other - Last Name:KAWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:1733 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5413
Practice Address - Country:US
Practice Address - Phone:815-385-0730
Practice Address - Fax:815-385-0572
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist