Provider Demographics
NPI:1588632806
Name:CHRISCO, PETER AUSTIN (PT)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:AUSTIN
Last Name:CHRISCO
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 1:6435 S FM 549 STE 102
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6221
Mailing Address - Country:US
Mailing Address - Phone:469-338-5162
Mailing Address - Fax:949-655-8774
Practice Address - Street 1:6435 S FM 549 STE 102
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6221
Practice Address - Country:US
Practice Address - Phone:469-338-5162
Practice Address - Fax:949-655-8774
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011972225100000X
GAPT0103252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08220357OtherBCBS GRP#
ILK28891OtherMEDICARE #
IL900068033OtherTAX-ID#
IL900068033OtherTAX-ID#