Provider Demographics
NPI:1710262928
Name:FOWLER, ALLISON DESHON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:DESHON
Last Name:FOWLER
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 1:383 CORBIN CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2909
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:1690 WEST HIGHWAY 192
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1673
Practice Address - Country:US
Practice Address - Phone:606-877-3231
Practice Address - Fax:606-877-3632
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005884225100000X
IL070018862225100000X
TN10666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01046468OtherMEDICARE RAILROAD
IL209812024Medicare PIN
IL202845258Medicare PIN