1790725042 NPI number — ALISON CHILTON ALBA DPT

Table of content: ALISON CHILTON ALBA DPT (NPI 1790725042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790725042 NPI number — ALISON CHILTON ALBA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBA
Provider First Name:
ALISON
Provider Middle Name:
CHILTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHILTON
Provider Other First Name:
ALISON
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790725042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6800 SOUTHPOINT PKWY STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-8203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-634-0640
Provider Business Mailing Address Fax Number:
904-825-2490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4565 US HIGHWAY 17 STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMING ISLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32003-4823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-634-0640
Provider Business Practice Location Address Fax Number:
904-634-0203
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT016844 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT30849 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50037534 . This is a "CAPITAL ADVANTAGE INS CO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50037534 . This is a "CAPITAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CH1622303 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0212106 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2299290000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".




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