Provider Demographics
NPI:1407547888
Name:CRIZALDO, CARLO
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:CRIZALDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 GATEWAY DR APT 5523
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5063
Mailing Address - Country:US
Mailing Address - Phone:757-597-3187
Mailing Address - Fax:
Practice Address - Street 1:9455 LORTON MARKET ST STE 201
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1965
Practice Address - Country:US
Practice Address - Phone:703-647-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist