Healthcare Provider Details

I. General information

NPI: 1538455290
Provider Name (Legal Business Name): ALISA BOWLING PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 GOVERNORS HILL DR
CINCINNATI OH
45249-1372
US

IV. Provider business mailing address

231 LONG MEADOW DR
FRANKLIN OH
45005-4671
US

V. Phone/Fax

Practice location:
  • Phone: 866-791-5766
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6014
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: