Provider Demographics
NPI:1770590051
Name:FENDER, ALLISON J (PT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:FENDER
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 1:2725 WATER RIDGE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-4580
Mailing Address - Country:US
Mailing Address - Phone:704-831-5065
Mailing Address - Fax:704-831-5066
Practice Address - Street 1:2725 WATER RIDGE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-4580
Practice Address - Country:US
Practice Address - Phone:704-831-5065
Practice Address - Fax:704-831-5066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734647OtherGROUP PRICING NUMBER
TN3734647OtherGROUP PRICING NUMBER