Individual
JAYLEN WILSON CRISOSTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2909 N 118TH ST STE 200, OMAHA, NE 68164-3643
(402) 509-5532
Mailing address
24500 WATTENBURG RD, COVELO, CA 95428-9758
(707) 489-2182
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
63660
OR
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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