Provider Demographics
NPI:1538639315
Name:FLUTY, ALLYSON FAITH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:FAITH
Last Name:FLUTY
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:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:CEREDO
Mailing Address - State:WV
Mailing Address - Zip Code:25507-1052
Mailing Address - Country:US
Mailing Address - Phone:304-730-8743
Mailing Address - Fax:
Practice Address - Street 1:335 JEFFERSON AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680
Practice Address - Country:US
Practice Address - Phone:740-894-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA012000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation