Provider Demographics
NPI:1578609947
Name:ALLISON, MICAH MARIE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:MARIE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 WILLIAMSBURG CT
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-3659
Mailing Address - Country:US
Mailing Address - Phone:251-957-0205
Mailing Address - Fax:
Practice Address - Street 1:6904 PROVIDENCE PARK DR S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4600
Practice Address - Country:US
Practice Address - Phone:251-639-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer