Provider Demographics
NPI:1104112978
Name:SANFORD, ALISON L (PT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:L
Last Name:SANFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:L
Other - Last Name:WILLSHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:STE. 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:1325 LOUISVILLE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6021
Practice Address - Country:US
Practice Address - Phone:318-807-1500
Practice Address - Fax:318-807-1504
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2164058Medicaid
LA3C615DD24Medicare PIN