Provider Demographics
NPI:1235509613
Name:BAUMGARDNER, ALLISON (PTA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BAUMGARDNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:VIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11811 MONTICETO LN
Mailing Address - Street 2:
Mailing Address - City:MEADOWS PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1716
Mailing Address - Country:US
Mailing Address - Phone:281-851-3875
Mailing Address - Fax:
Practice Address - Street 1:11811 MONTICETO LN
Practice Address - Street 2:
Practice Address - City:MEADOWS PLACE
Practice Address - State:TX
Practice Address - Zip Code:77477-1716
Practice Address - Country:US
Practice Address - Phone:281-851-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2112492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant