Provider Demographics
NPI:1699266254
Name:TREADWELL, ALISHA
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22181 LAKE JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-6553
Mailing Address - Country:US
Mailing Address - Phone:804-926-3037
Mailing Address - Fax:804-926-3037
Practice Address - Street 1:22181 LAKE JORDAN DR
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-6553
Practice Address - Country:US
Practice Address - Phone:804-926-3037
Practice Address - Fax:804-926-3037
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist