Provider Demographics
NPI:1790725042
Name:ALBA, ALISON CHILTON (DPT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:CHILTON
Last Name:ALBA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:LORRAINE
Other - Last Name:CHILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6800 SOUTHPOINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8203
Mailing Address - Country:US
Mailing Address - Phone:904-634-0640
Mailing Address - Fax:904-825-2490
Practice Address - Street 1:4565 US HIGHWAY 17 STE 200
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4823
Practice Address - Country:US
Practice Address - Phone:904-634-0640
Practice Address - Fax:904-634-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016844225100000X
FLPT30849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50037534OtherCAPITAL ADVANTAGE INS CO
PA50037534OtherCAPITAL
PACH1622303OtherHIGHMARK
0212106OtherCIGNA
2299290000OtherKEYSTONE HEALTH PLAN EAST