Basic Information
Provider Information
NPI: 1932612090
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMOS
FirstName: ALLISON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
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OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2965 E TARPON DR
Address2: STE 150
City: MERIDIAN
State: ID
PostalCode: 836429007
CountryCode: US
TelephoneNumber: 7018521399
FaxNumber: 7018380613
Practice Location
Address1: 101 3RD AVE SW
Address2:  
City: MINOT
State: ND
PostalCode: 587013880
CountryCode: US
TelephoneNumber: 7018575286
FaxNumber: 7018575697
Other Information
ProviderEnumerationDate: 11/13/2017
LastUpdateDate: 06/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2230NDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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