Provider Demographics
NPI:1750765129
Name:ALLISON, COLLIN JAMES (PTA)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:JAMES
Last Name:ALLISON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3773
Mailing Address - Country:US
Mailing Address - Phone:806-780-7433
Mailing Address - Fax:806-780-7434
Practice Address - Street 1:6014 45TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-3773
Practice Address - Country:US
Practice Address - Phone:806-780-7433
Practice Address - Fax:806-780-7434
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111512208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation