Provider Demographics
NPI:1639234719
Name:DIMATTIA, ALLISON (DPT, PT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DIMATTIA
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28977 WALKER SOUTH ROAD
Mailing Address - Street 2:STE. G
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785
Mailing Address - Country:US
Mailing Address - Phone:225-271-8056
Mailing Address - Fax:
Practice Address - Street 1:28977 WALKER SOUTH ROAD
Practice Address - Street 2:STE. G
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785
Practice Address - Country:US
Practice Address - Phone:225-271-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist