Healthcare Provider Details

I. General information

NPI: 1457985384
Provider Name (Legal Business Name): ALANA ROSE RADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2020
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 E 54TH ST
DAVENPORT IA
52807-2769
US

IV. Provider business mailing address

1749 E 54TH ST
DAVENPORT IA
52807-2769
US

V. Phone/Fax

Practice location:
  • Phone: 563-468-3727
  • Fax: 563-396-1905
Mailing address:
  • Phone: 563-468-3727
  • Fax: 563-396-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number129821
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: