Individual
DR. DAVID BRIAN CRISCOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
800 W LINCOLN TRAIL BLVD STE 103, RADCLIFF, KY 40160-2671
(270) 352-1061
(270) 352-1067
Mailing address
800 W LINCOLN TRAIL BLVD STE 103, RADCLIFF, KY 40160-2671
(270) 352-1061
(270) 352-1067
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004308
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000238482
BCBS
KY
01
—
1861419319
RAIL ROAD MEDICARE
KY
01
—
50000935
PASSPORT HEALTH
KY
05
—
8700086500
—
KY
Enumeration date
07/17/2006
Last updated
12/28/2010
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