Provider Demographics
NPI:1164595583
Name:BOLT, ALLISON BUCKNER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:BUCKNER
Last Name:BOLT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:DAWN
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:720 CHRIS HILL DR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3244
Mailing Address - Country:US
Mailing Address - Phone:865-579-9829
Mailing Address - Fax:
Practice Address - Street 1:3305 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1035
Practice Address - Country:US
Practice Address - Phone:615-386-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002493225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant