Provider Demographics
NPI:1215207915
Name:ALLSHOUSE, PATRICIA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:ALLSHOUSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IL
Mailing Address - Zip Code:61256-9617
Mailing Address - Country:US
Mailing Address - Phone:309-269-7630
Mailing Address - Fax:
Practice Address - Street 1:2545 24TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5305
Practice Address - Country:US
Practice Address - Phone:309-788-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.002157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant