Provider Demographics
NPI:1497305221
Name:MANLEY, ALLISON J (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:MANLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 W COLLEGE DR STE D
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1197
Mailing Address - Country:US
Mailing Address - Phone:708-671-1374
Mailing Address - Fax:
Practice Address - Street 1:7530 W COLLEGE DR STE D
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1197
Practice Address - Country:US
Practice Address - Phone:708-671-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085008770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant