Provider Demographics
NPI:1952823536
Name:SMITH, ALLISON (PT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E BRADFORD PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6781
Mailing Address - Country:US
Mailing Address - Phone:417-881-2900
Mailing Address - Fax:
Practice Address - Street 1:1630 E BRADFORD PKWY STE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6781
Practice Address - Country:US
Practice Address - Phone:417-881-2900
Practice Address - Fax:417-881-2918
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014019527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist