Provider Demographics
NPI:1306083704
Name:CHISMAR, ABY E (DPT)
Entity type:Individual
Prefix:
First Name:ABY
Middle Name:E
Last Name:CHISMAR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4806
Mailing Address - Country:US
Mailing Address - Phone:330-726-9671
Mailing Address - Fax:330-726-4232
Practice Address - Street 1:277 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4806
Practice Address - Country:US
Practice Address - Phone:330-726-9671
Practice Address - Fax:330-726-4232
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3144047Medicaid
OH4307531Medicare PIN