Provider Demographics
NPI:1619347341
Name:VALLADOLID, ALLISON DECKER (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DECKER
Last Name:VALLADOLID
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 N CAMINO MERCADO STE 25
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5757
Mailing Address - Country:US
Mailing Address - Phone:855-331-7522
Mailing Address - Fax:888-381-6179
Practice Address - Street 1:580 N CAMINO MERCADO STE 25
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5757
Practice Address - Country:US
Practice Address - Phone:855-331-7522
Practice Address - Fax:888-381-6179
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11773PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist