Provider Demographics
NPI:1710961321
Name:SURAN, ALLISON KAYE (PT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KAYE
Last Name:SURAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:KAYE
Other - Last Name:SCHUMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20813 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8750
Mailing Address - Country:US
Mailing Address - Phone:541-390-6723
Mailing Address - Fax:
Practice Address - Street 1:404 NE PENN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4264
Practice Address - Country:US
Practice Address - Phone:541-318-7041
Practice Address - Fax:541-388-3711
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201046Medicaid
OR570944OtherPROVIDENCE
ORH254801OtherPACIFIC SOURCE
OR201046Medicaid
ORH254801OtherPACIFIC SOURCE