Provider Demographics
NPI:1740921675
Name:ROULI, CRYSTAL ABIGAIL (DPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ABIGAIL
Last Name:ROULI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16049 TUSCOLA RD STE A
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0824
Mailing Address - Country:US
Mailing Address - Phone:760-503-5455
Mailing Address - Fax:
Practice Address - Street 1:16049 TUSCOLA RD STE A
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-0824
Practice Address - Country:US
Practice Address - Phone:760-503-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist