Provider Demographics
NPI:1992227920
Name:LOUDENBACK, ALLISON (PT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:LOUDENBACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:COLLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9602 COLDWATER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2095
Mailing Address - Country:US
Mailing Address - Phone:260-489-9887
Mailing Address - Fax:260-489-9121
Practice Address - Street 1:9602 COLDWATER RD STE 102
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2095
Practice Address - Country:US
Practice Address - Phone:260-489-9887
Practice Address - Fax:260-489-9121
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99079812A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist