MEDICARE: THOMAS CRISS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1295574705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS CRISS

Provider Business Mailing Address
First Line	:	2435 AUTUMN VALLEY DR APT 205
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-7060
Country	:	US
Telephone Number	:	336-655-7714
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S STRATFORD RD STE 523
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3217
Country	:	US
Telephone Number	:	470-333-6765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/23/2024

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Directions to “ THOMAS CRISS ” Practice Location

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