Provider Demographics
NPI:1679622385
Name:WIRT, ALLISON H (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:H
Last Name:WIRT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:ALLISON
Other - Middle Name:LEIGH
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:300B TEMPLE LAKE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2973
Practice Address - Country:US
Practice Address - Phone:804-524-9036
Practice Address - Fax:804-524-9039
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7058866OtherAETNA
VA010306060Medicaid
VA192946OtherBCBS (PHYS. THERAPY)
VAP00395286OtherRAILROAD MEDICARE
VA7058866OtherAETNA
VA012208T54Medicare PIN