Provider Demographics
NPI:1255678199
Name:DOUGLASS, ALLISON K (PTA)
Entity Type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:K
Last Name:DOUGLASS
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 1:6707 PALACE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1018
Mailing Address - Country:US
Mailing Address - Phone:402-613-7951
Mailing Address - Fax:
Practice Address - Street 1:6707 PALACE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1018
Practice Address - Country:US
Practice Address - Phone:402-613-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12804225200000X
NE1124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant