Provider Demographics
NPI:1629559380
Name:MUTH, ALLISON (DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MUTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 DELAWARE AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1124
Mailing Address - Country:US
Mailing Address - Phone:585-419-5849
Mailing Address - Fax:
Practice Address - Street 1:9392 SULLIVAN VALE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7073
Practice Address - Country:US
Practice Address - Phone:980-701-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NCP19442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist