Provider Demographics
NPI:1639651540
Name:ALLISON, MICAH (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SEVEN SPRINGS WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4576
Mailing Address - Country:US
Mailing Address - Phone:615-370-9992
Mailing Address - Fax:615-370-9665
Practice Address - Street 1:5380 HICKORY HOLLOW PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3389
Practice Address - Country:US
Practice Address - Phone:615-891-2070
Practice Address - Fax:615-891-2056
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist