Basic Information
| Provider Information | |||||||||
| NPI: | 1790725042 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBA | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | CHILTON | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHILTON | ||||||||
| OtherFirstName: | ALISON | ||||||||
| OtherMiddleName: | LORRAINE | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 ORTHOPAEDIC PL | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320864202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048250540 | ||||||||
| FaxNumber: | 9048252490 | ||||||||
| Practice Location | |||||||||
| Address1: | 3055 COUNTY ROAD 210 W | ||||||||
| Address2: | UNIT #111 | ||||||||
| City: | SAINT JOHNS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322597000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048250540 | ||||||||
| FaxNumber: | 9048252490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT016844 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT30849 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 50037534 | 01 | PA | CAPITAL | OTHER | 50037534 | 01 | CAPITAL ADVANTAGE INS CO | OTHER | 2299290000 | 01 | KEYSTONE HEALTH PLAN EAST | OTHER | CH1622303 | 01 | PA | HIGHMARK | OTHER | 0212106 | 01 | CIGNA | OTHER |