Healthcare Provider Details

I. General information

NPI: 1336987692
Provider Name (Legal Business Name): ALLYSON S GOLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14765 HAZEL DELL XING STE 100
NOBLESVILLE IN
46062-7046
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 317-218-0180
  • Fax: 317-779-0229
Mailing address:
  • Phone: 630-575-1980
  • Fax: 630-928-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05015216A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: