Provider Demographics
NPI:1467246702
Name:CRISMAN, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:CRISMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 LYNTZ TOWNLINE RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9262
Mailing Address - Country:US
Mailing Address - Phone:330-423-3656
Mailing Address - Fax:
Practice Address - Street 1:60 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1914
Practice Address - Country:US
Practice Address - Phone:330-259-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0215882251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic