Healthcare Provider Details

I. General information

NPI: 1386555191
Provider Name (Legal Business Name): MATTHEW SERFONTEIN CRISLER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 HARRISON AVE STE A
CENTRALIA WA
98531-1300
US

IV. Provider business mailing address

7358 EASTLAKE RD
STERLINGTON LA
71280-3214
US

V. Phone/Fax

Practice location:
  • Phone: 360-870-2473
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12516R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: