Provider Demographics
NPI:1679927073
Name:CAVALLO, CRISTINA ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELIZABETH
Last Name:CAVALLO
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-0500
Mailing Address - Country:US
Mailing Address - Phone:301-498-8100
Mailing Address - Fax:
Practice Address - Street 1:14235 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5261
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA016442002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics