Healthcare Provider Details

I. General information

NPI: 1093420630
Provider Name (Legal Business Name): CRESCENDO THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 WESTERN BRANCH BLVD
PORTSMOUTH VA
23707-2534
US

IV. Provider business mailing address

1413 CAMPOSTELLA RD
CHESAPEAKE VA
23320-6003
US

V. Phone/Fax

Practice location:
  • Phone: 757-955-3390
  • Fax:
Mailing address:
  • Phone: 757-955-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code226000000X
TaxonomyRecreational Therapist Assistant
License Number
License Number State

VIII. Authorized Official

Name: GINA B STUKES
Title or Position: OWNER
Credential:
Phone: 757-955-3390