Provider Demographics
NPI:1093380933
Name:KISLING- SCRIMA, SAVANNAH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:KISLING- SCRIMA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:KISLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:90 E USTICK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6134
Mailing Address - Country:US
Mailing Address - Phone:208-895-0715
Mailing Address - Fax:208-895-0746
Practice Address - Street 1:90 E USTICK RD STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6134
Practice Address - Country:US
Practice Address - Phone:208-895-0715
Practice Address - Fax:208-895-0746
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist