Individual
JAN CRISOSTOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
701 S OAK ST, WINCHESTER, IN 47394-2229
(765) 584-2201
Mailing address
701 S OAK ST, WINCHESTER, IN 47394-2229
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05011978A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05011978A
—
IN
Enumeration date
03/07/2017
Last updated
03/07/2017
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