Provider Demographics
NPI:1881065688
Name:FITZWATER, CRYSTAL ASWELL (DPT)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ASWELL
Last Name:FITZWATER
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 1:708 TURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6030
Mailing Address - Country:US
Mailing Address - Phone:757-617-2081
Mailing Address - Fax:
Practice Address - Street 1:708 TURLINGTON RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6030
Practice Address - Country:US
Practice Address - Phone:757-617-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist