Provider Demographics
NPI:1871799718
Name:ALLISON, CARISA (DPT)
Entity type:Individual
Prefix:
First Name:CARISA
Middle Name:
Last Name:ALLISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 223RD ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52567-8534
Mailing Address - Country:US
Mailing Address - Phone:641-693-4050
Mailing Address - Fax:
Practice Address - Street 1:1788 223RD ST
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IA
Practice Address - Zip Code:52567-8534
Practice Address - Country:US
Practice Address - Phone:641-693-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist