Provider Demographics
NPI:1982169132
Name:TUBBS, ALLISON (PTA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TUBBS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 12TH AVE S APT 10
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4880
Mailing Address - Country:US
Mailing Address - Phone:803-743-6499
Mailing Address - Fax:
Practice Address - Street 1:3018 RATTLESNAKE DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-6101
Practice Address - Country:US
Practice Address - Phone:406-549-0988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15079225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant