Provider Demographics
NPI:1194045484
Name:DURHAM, ALLISON JEAN (PT, DPT, RN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JEAN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PT, DPT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E LUTZ RD
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502-3211
Mailing Address - Country:US
Mailing Address - Phone:419-446-9144
Mailing Address - Fax:419-446-9146
Practice Address - Street 1:815 E LUTZ RD
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-3211
Practice Address - Country:US
Practice Address - Phone:419-446-9144
Practice Address - Fax:419-446-9146
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318903163W00000X
OHPT012828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No163W00000XNursing Service ProvidersRegistered Nurse