Provider Demographics
NPI:1063915726
Name:CRISP, ALLISON JILL (DPT, MTC)
Entity type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:JILL
Last Name:CRISP
Suffix:
Gender:F
Credentials:DPT, MTC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CLARK
Other - Last Name:CRISP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT, MTC
Mailing Address - Street 1:308 AVALON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-4042
Mailing Address - Country:US
Mailing Address - Phone:423-506-4961
Mailing Address - Fax:
Practice Address - Street 1:308 AVALON ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4042
Practice Address - Country:US
Practice Address - Phone:423-506-4961
Practice Address - Fax:423-745-7132
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist