Provider Demographics
NPI:1073244133
Name:CASINO-CHISHOLM, KRISNA MARIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KRISNA MARIE
Middle Name:
Last Name:CASINO-CHISHOLM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 COPPER KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7222
Mailing Address - Country:US
Mailing Address - Phone:434-466-5942
Mailing Address - Fax:
Practice Address - Street 1:1600 GORDON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1918
Practice Address - Country:US
Practice Address - Phone:434-293-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist