Phaedra Crisman, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202005546 Issued in VA

Practice address

44 Broad Street Rd
Route 250
Manakin Sabot, VA 23103-2213

Phone

(804) 784-7090

Fax

(804) 784-7092

NPI assigned

Oct 31, 2016

Last updated

Oct 31, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pivot Physical Therapy of Pennsylvania, LLC

  • Physical Therapist
  • South Abington Township, PA
  • NPI 1881132488

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477872000000",
    "number": "1699227256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 NORTHERN BLVD",
            "city": "SOUTH ABINGTON TOWNSHIP",
            "state": "PA",
            "postal_code": "184118740",
            "telephone_number": "570-842-9323",
            "fax_number": "570-842-9362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 BROAD STREET RD",
            "address_2": "ROUTE 250",
            "city": "MANAKIN SABOT",
            "state": "VA",
            "postal_code": "231032213",
            "telephone_number": "804-784-7090",
            "fax_number": "804-784-7092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISMAN",
        "first_name": "PHAEDRA",
        "credential": "SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-31",
        "last_updated": "2016-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202005546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric R. Carlsen, D.C.
• Callie A. Carter, DPT
• Centerville Cardinal Drug Center Inc (Gunns Pharmacy Inc)
• Nelson Chen Fernandez, M.D.
• Elizabeth C Cheng, DDS
• Gabrielle Defazio
• Jennifer M Dickerson, OTRL
• Stephanie Dodd, SLP
• Dr.Peter Guhl
• Emilie Bonovitch Ellis, RDH

• Speech-Language Pathologist in Manakin Sabot, VA
• Providers in Manakin Sabot, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.