Provider Demographics
NPI:1770822686
Name:CRISP, ELISABETH ASHLEY B (DPT)
Entity Type:Individual
Prefix:
First Name:ELISABETH ASHLEY
Middle Name:B
Last Name:CRISP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:ASHLEY
Other - Last Name:BOYKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:251 JOHNSTON STREET SE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:250-340-9708
Mailing Address - Fax:
Practice Address - Street 1:42465 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7052
Practice Address - Country:US
Practice Address - Phone:205-486-2753
Practice Address - Fax:205-486-2109
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist