Provider Demographics
NPI:1518388685
Name:FEDALIZO, CRIS
Entity Type:Individual
Prefix:
First Name:CRIS
Middle Name:
Last Name:FEDALIZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6564 LOISDALE CT STE 500
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1823
Mailing Address - Country:US
Mailing Address - Phone:703-822-0039
Mailing Address - Fax:
Practice Address - Street 1:6564 LOISDALE CT STE 500
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1823
Practice Address - Country:US
Practice Address - Phone:703-822-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213659225100000X
IL070.019651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist