Provider Demographics
NPI:1215023346
Name:MIDURI, ALISHA D (MPT)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:D
Last Name:MIDURI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:2032 E PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-7515
Practice Address - Country:US
Practice Address - Phone:814-944-8264
Practice Address - Fax:814-944-7904
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013547L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7343147OtherAETNA
PA624028OtherHIGHMARK BLUE SHIELD
PA270685OtherHEALTH AMER/HEALTH ASSUR.
PA7343147OtherAETNA