Provider Demographics
NPI:1801838636
Name:DUVALL, ALLYSON A (RPT)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:A
Last Name:DUVALL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:A
Other - Last Name:PARKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:3194 SOUTHFORK DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-7003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3194 SOUTHFORK DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-7003
Practice Address - Country:US
Practice Address - Phone:601-540-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3209225100000X
FLPT30521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05583011Medicaid