Healthcare Provider Details

I. General information

NPI: 1699588111
Provider Name (Legal Business Name): JOSHUA V CRISANO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

13126 ADAMS ST
QUANTICO VA
22134-4211
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1651
  • Fax:
Mailing address:
  • Phone: 757-342-1157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: