Provider Demographics
NPI:1093423857
Name:CRISP, SAMUEL RICHARD (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RICHARD
Last Name:CRISP
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-1046
Mailing Address - Country:US
Mailing Address - Phone:419-234-0317
Mailing Address - Fax:
Practice Address - Street 1:3156 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8024
Practice Address - Country:US
Practice Address - Phone:305-292-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT394852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic