Provider Demographics
NPI:1760627400
Name:GIDDENS, ALISON ADAMS (MPT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ADAMS
Last Name:GIDDENS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0528
Mailing Address - Country:US
Mailing Address - Phone:706-527-4207
Mailing Address - Fax:706-528-4211
Practice Address - Street 1:1711 MARTHA BERRY BLVD NW STE 104
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1623
Practice Address - Country:US
Practice Address - Phone:706-528-4207
Practice Address - Fax:706-528-4211
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000902382BMedicaid