Provider Demographics
NPI:1366048381
Name:LUND, ALLISON JANE (PTA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:JANE
Last Name:LUND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6728
Mailing Address - Country:US
Mailing Address - Phone:618-978-8080
Mailing Address - Fax:
Practice Address - Street 1:100 GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6759
Practice Address - Country:US
Practice Address - Phone:618-978-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009024225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant