Provider Demographics
NPI:1801385950
Name:WISDOM, ALAINA DANIELLE (DPT)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:DANIELLE
Last Name:WISDOM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:DANIELLE
Other - Last Name:DAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:199 N BROOKMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2024
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:2555 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501
Practice Address - Country:US
Practice Address - Phone:205-385-7919
Practice Address - Fax:205-385-7920
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist