Provider Demographics
NPI:1538905542
Name:CHRISMAN, GLENDA DEEDEE
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:DEEDEE
Last Name:CHRISMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16219 RANCH ROAD 620 N
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5209
Mailing Address - Country:US
Mailing Address - Phone:512-520-1834
Mailing Address - Fax:
Practice Address - Street 1:16219 RANCH ROAD 620 N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5209
Practice Address - Country:US
Practice Address - Phone:512-520-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2037158225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant