Basic Information
| Provider Information | |||||||||
| NPI: | 1639651540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLISON | ||||||||
| FirstName: | MICAH | ||||||||
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| Credential: | PT, DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 SEVEN SPRINGS WAY STE 101 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153709992 | ||||||||
| FaxNumber: | 6153709665 | ||||||||
| Practice Location | |||||||||
| Address1: | 5380 HICKORY HOLLOW PKWY STE 201 | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370133389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158912070 | ||||||||
| FaxNumber: | 6158912056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2018 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11967 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.