Provider Demographics
NPI:1780193706
Name:CRITELLI, JAMES THOMAS
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:CRITELLI
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 1:628 LINNWILL PL
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3720
Mailing Address - Country:US
Mailing Address - Phone:515-720-8386
Mailing Address - Fax:
Practice Address - Street 1:2619 SW 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-1910
Practice Address - Country:US
Practice Address - Phone:515-720-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer