Healthcare Provider Details

I. General information

NPI: 1457658015
Provider Name (Legal Business Name): DONALD LEE ALLISON II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4190 CITY AVE SUITE 330
PHILADELPHIA PA
19131-1626
US

IV. Provider business mailing address

4190 CITY AVE SUITE 330
PHILADELPHIA PA
19131-1626
US

V. Phone/Fax

Practice location:
  • Phone: 215-871-6425
  • Fax: 215-871-6490
Mailing address:
  • Phone: 215-871-6425
  • Fax: 215-871-6490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS015708
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: