Provider Demographics
NPI:1093385478
Name:LACKEY, ALLISON ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:LACKEY
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 1:109 THORNE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2565
Mailing Address - Country:US
Mailing Address - Phone:847-722-3103
Mailing Address - Fax:
Practice Address - Street 1:151 W MINERAL AVE STE 116A
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4510
Practice Address - Country:US
Practice Address - Phone:303-798-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist