Provider Demographics
NPI:1174810410
Name:PREBBLE, CRYSONNA R (PT)
Entity type:Individual
Prefix:
First Name:CRYSONNA
Middle Name:R
Last Name:PREBBLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CRYSONNA
Other - Middle Name:R
Other - Last Name:LINDSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 MONROE STREET
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-838-2040
Mailing Address - Fax:301-838-2041
Practice Address - Street 1:30 WEST GUDE DRIVE
Practice Address - Street 2:SUITE 160
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-251-3757
Practice Address - Fax:301-251-3731
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist