Provider Demographics
NPI:1891343927
Name:ALLS, THERESA KAY
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:KAY
Last Name:ALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7431 BRIDE WATER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4300
Mailing Address - Country:US
Mailing Address - Phone:614-792-3596
Mailing Address - Fax:
Practice Address - Street 1:7431 BRIDE WATER BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4300
Practice Address - Country:US
Practice Address - Phone:614-792-3596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider