Provider Demographics
NPI:1740304153
Name:ALLISON, JOSHUA C (C-PED)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:ALLISON
Suffix:
Gender:M
Credentials:C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 S STATE ROUTE 159
Mailing Address - Street 2:STE 1
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3231
Mailing Address - Country:US
Mailing Address - Phone:618-288-9297
Mailing Address - Fax:618-288-1260
Practice Address - Street 1:4225 S STATE ROUTE 159
Practice Address - Street 2:STE 1
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3231
Practice Address - Country:US
Practice Address - Phone:618-288-9297
Practice Address - Fax:618-288-1260
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier