Provider Demographics
NPI:1356061337
Name:PRAD, ALLISON (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PRAD
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6990 ANNIE WALK
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4677
Mailing Address - Country:US
Mailing Address - Phone:678-373-5539
Mailing Address - Fax:
Practice Address - Street 1:6990 ANNIE WALK
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4677
Practice Address - Country:US
Practice Address - Phone:678-780-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN090010164W00000X
GAMT014020225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse