Provider Demographics
NPI:1508114851
Name:CRISMON, DARREN (PT)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:CRISMON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 E THOUSAND OAKS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3445
Mailing Address - Country:US
Mailing Address - Phone:805-374-9900
Mailing Address - Fax:805-374-9910
Practice Address - Street 1:3262 E THOUSAND OAKS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-3445
Practice Address - Country:US
Practice Address - Phone:805-374-9900
Practice Address - Fax:805-374-9910
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT392352251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic