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NPI Code Detail

MEDICARE: VALERIE CREVISTON DPT

MEDICARE: VALERIE CREVISTON DPT
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
1225100000XPhysical Therapist070.014331IL

General Provider Information

NPI Number : 1093856569
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE CREVISTON DPT
Provider Business Mailing Address
First Line : 101 E PLUMMER BLVD
Second Line :
City : CHATHAM
State : IL
Zip : 62629-8047
Country : US
Telephone Number : 217-483-8171
Fax Number : 217-483-8173
Provider Business Practice Location Address
First Line : 101 E PLUMMER BLVD
Second Line :
City : CHATHAM
State : IL
Zip : 62629-8047
Country : US
Telephone Number : 214-483-8171
Fax Number : 217-483-8173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 08/05/2014

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Directions to “ VALERIE CREVISTON DPT” Practice Location

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