Provider Demographics
NPI:1205915907
Name:KLOEHS, ALLISON C (PT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:C
Last Name:KLOEHS
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 1:100 MILLBROOK VILLAGE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-3603
Mailing Address - Country:US
Mailing Address - Phone:678-364-9412
Mailing Address - Fax:678-364-9413
Practice Address - Street 1:100 MILLBROOK VILLAGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-3603
Practice Address - Country:US
Practice Address - Phone:678-364-9412
Practice Address - Fax:678-364-9413
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA005883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA005883OtherSTATE LISC NUMBER