Provider Demographics
NPI:1457985384
Name:RADLEY, ALANA ROSE
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:ROSE
Last Name:RADLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2769
Mailing Address - Country:US
Mailing Address - Phone:563-468-3727
Mailing Address - Fax:563-396-1905
Practice Address - Street 1:1749 E 54TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2769
Practice Address - Country:US
Practice Address - Phone:563-468-3727
Practice Address - Fax:563-396-1905
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
IA129821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer