Provider Demographics
NPI:1962673269
Name:VENDRELL, CRYSTAL MIRIAH (DPT)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MIRIAH
Last Name:VENDRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1076 W CHANDLER BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5225
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-4912
Practice Address - Street 1:3921 E BASELINE RD
Practice Address - Street 2:STE 108
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2727
Practice Address - Country:US
Practice Address - Phone:480-503-2373
Practice Address - Fax:480-503-2375
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ79152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic