Provider Demographics
NPI:1104281559
Name:CRISWELL, DARREN (DPT)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:CRISWELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:ND
Mailing Address - Zip Code:58623-0009
Mailing Address - Country:US
Mailing Address - Phone:701-523-7848
Mailing Address - Fax:
Practice Address - Street 1:14 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:ND
Practice Address - Zip Code:58623-0009
Practice Address - Country:US
Practice Address - Phone:701-523-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist