Provider Demographics
NPI:1609205970
Name:CHRISMON, JENNIE MOERBE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MOERBE
Last Name:CHRISMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BOEHM DR
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-6288
Mailing Address - Country:US
Mailing Address - Phone:361-594-8301
Mailing Address - Fax:361-594-3033
Practice Address - Street 1:105 BOEHM DR
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984-6288
Practice Address - Country:US
Practice Address - Phone:361-594-8301
Practice Address - Fax:361-594-3033
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist