Provider Demographics
NPI:1538268222
Name:DWORSCHAK, ALLISON (MSR, PT, PCS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DWORSCHAK
Suffix:
Gender:F
Credentials:MSR, PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 N MAIN ST STE M
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-7380
Mailing Address - Country:US
Mailing Address - Phone:843-814-0724
Mailing Address - Fax:843-970-2470
Practice Address - Street 1:801 PINE BLUFF DR
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-1649
Practice Address - Country:US
Practice Address - Phone:843-814-0724
Practice Address - Fax:843-970-2470
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1334Medicaid