Provider Demographics
NPI:1023629565
Name:BAINES, ALLISON GRACE (PTA)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:GRACE
Last Name:BAINES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 MAPLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-6112
Mailing Address - Country:US
Mailing Address - Phone:757-869-7906
Mailing Address - Fax:
Practice Address - Street 1:8911 MAPLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-6112
Practice Address - Country:US
Practice Address - Phone:757-869-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604997225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant