Healthcare Provider Details

I. General information

NPI: 1780102103
Provider Name (Legal Business Name): ALLISON RENEE HUTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GRENOBLE PL
REHOBOTH BEACH DE
19971-2847
US

IV. Provider business mailing address

1 GRENOBLE PL
REHOBOTH BEACH DE
19971-2847
US

V. Phone/Fax

Practice location:
  • Phone: 302-226-2691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0003795
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: