Provider Demographics
NPI:1275662306
Name:CRISMALI, JOHN STEVEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:STEVEN
Last Name:CRISMALI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 OLD MEADOW RD APT 621
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-1822
Mailing Address - Country:US
Mailing Address - Phone:703-288-4538
Mailing Address - Fax:
Practice Address - Street 1:1800 OLD MEADOW RD APT 621
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-1822
Practice Address - Country:US
Practice Address - Phone:703-288-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490-584Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER