Provider Demographics
NPI:1245298868
Name:PRATT, ALLISON LISA (PT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LISA
Last Name:PRATT
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:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04648
Mailing Address - Country:US
Mailing Address - Phone:207-255-5928
Mailing Address - Fax:207-255-5958
Practice Address - Street 1:5 STOCKPOLE RD
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-5928
Practice Address - Fax:207-255-5958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME206513Medicare ID - Type Unspecified