MEDICARE: CRISPIN DALSING

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	363334-2401	UT

General Provider Information

NPI Number	:	1649233149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISPIN DALSING

Provider Business Mailing Address
First Line	:	250 W 300 N
Second Line	:
City	:	ROOSEVELT
State	:	UT
Zip	:	84066-2336
Country	:	US
Telephone Number	:	435-722-6163
Fax Number	:	435-722-9291

Provider Business Practice Location Address
First Line	:	250 W 300 N
Second Line	:
City	:	ROOSEVELT
State	:	UT
Zip	:	84066-2336
Country	:	US
Telephone Number	:	435-722-6163
Fax Number	:	435-722-9291

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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Directions to “ CRISPIN DALSING ” Practice Location

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