1255850558 NPI number — ALLISON TANG PT, DPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255850558 NPI number — ALLISON TANG PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANG
Provider First Name:
ALLISON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
ALLISON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255850558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 E 1ST ST UNIT 213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULF SHORES
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36542-6675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-417-7735
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3947 GULF SHORES PKWY STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULF SHORES
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36542-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-943-0803
Provider Business Practice Location Address Fax Number:
251-943-4403
Provider Enumeration Date:
09/18/2017

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:  PTH10234 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5099 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 14526 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5099 . This is a "NM PHYSICAL THERAPY BOARD LICENSURE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: PTH10234 . This is a "ALABAMA BOARD OF PHYSICAL THERAPY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 37114 . This is a "STATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PTL15761 . This is a "COLORADO BOARD OF PHYSICAL THERAPY" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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