Provider Demographics
NPI:1285691147
Name:ALLISON, LEA J (PT)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:J
Last Name:ALLISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:580 LAFAYETTE RD STE K
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3483
Mailing Address - Country:US
Mailing Address - Phone:862-268-0582
Mailing Address - Fax:973-860-4282
Practice Address - Street 1:580 LAFAYETTE RD STE K
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3483
Practice Address - Country:US
Practice Address - Phone:862-268-0582
Practice Address - Fax:973-860-4282
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00763000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ022322SQSMedicare Oscar/Certification