Phaedra Crisman, SLP
Individual provider Active NPI Speech-Language Pathologist · Manakin Sabot, VA
NPI 1699227256 · NPPES record last updated Oct 31, 2016
Key facts
- NPI
- 1699227256
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2202005546 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pivot Physical Therapy of Pennsylvania, LLC | Speech-Language Pathologist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2202005546 | VA | Yes |
Addresses
Primary practice location
44 Broad Street Rd
Route 250
Manakin Sabot, VA 23103-2213
Mailing address
655 Northern Blvd
South Abington Township, PA 18411-8740
Phone (570) 842-9323
Other providers in Manakin Sabot, VA
- Eric R. Carlsen
- Callie A. Carter
- Centerville Cardinal Drug Center Inc
- Nelson Chen Fernandez
- Elizabeth C Cheng
- Gabrielle Defazio
- Jennifer M Dickerson
- Stephanie Dodd
- Dr.Peter Guhl
- Emilie Bonovitch Ellis
All providers in Manakin Sabot, VA · Speech-Language Pathologist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.