Healthcare Provider Details

I. General information

NPI: 1811415862
Provider Name (Legal Business Name): ALLISON GWEN SARKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 DUDLEY DR
WEST CHESTER OH
45069-2400
US

IV. Provider business mailing address

6622 CLOVER LN APT A
LIBERTY TOWNSHIP OH
45044-1168
US

V. Phone/Fax

Practice location:
  • Phone: 513-779-5410
  • Fax:
Mailing address:
  • Phone: 860-942-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020032
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT006574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: