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General NPI Number Information
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NPI Number | 1114340593
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Entity Type | Individual
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Provider Name | DONALD BERLAN ALLISON A.D. PTA
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Gender | Male
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 4405 AIRLINE DR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2058
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Country | US
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Telephone | 318-747-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E STATE ST
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City | KENNETT SQUARE
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State | PA
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Zip | 19348-3109
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Country | US
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Telephone | 610-925-4239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A7927
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License Number State | LA
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