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General NPI Number Information
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NPI Number | 1306954276
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Entity Type | Individual
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Provider Name | TYSON CARTER CRISMAN MPT
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 102 MEDICAL CENTER DR STE G
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City | PRATTVILLE
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State | AL
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Zip | 36066-7286
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Country | US
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Telephone | 334-239-0708
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Fax | 334-440-8233
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Provider Business Mailing Address
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Address Line | 302 TAPIA LN
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City | PRATTVILLE
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State | AL
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Zip | 36067-6992
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Country | US
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Telephone | 334-546-8822
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH4381
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License Number State | AL
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