Provider Demographics
NPI:1073984068
Name:WILSON, ALLISON PAIGE (AT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PAIGE
Last Name:WILSON
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 S COUNTRY CLUB DR APT 2118
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8668
Mailing Address - Country:US
Mailing Address - Phone:219-315-3477
Mailing Address - Fax:
Practice Address - Street 1:2318 S COUNTRY CLUB DR APT 2118
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-8668
Practice Address - Country:US
Practice Address - Phone:219-315-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer