Provider Demographics
NPI:1073630349
Name:ALBRIGHT, ALISHA
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:ALBRIGHT
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 1:401 US HIGHWAY 24/36 E
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63456-1351
Mailing Address - Country:US
Mailing Address - Phone:573-735-4632
Mailing Address - Fax:573-735-2413
Practice Address - Street 1:401 US HIGHWAY 24/36 E
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:MO
Practice Address - Zip Code:63456-1351
Practice Address - Country:US
Practice Address - Phone:573-735-4632
Practice Address - Fax:573-735-2413
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110375251300000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO488919036Medicaid