Provider Demographics
NPI:1649432725
Name:CAUDILL, ALLISON EULENE (PTA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:EULENE
Last Name:CAUDILL
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 1:166 AC DRIVE HWY 119 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823-9701
Mailing Address - Country:US
Mailing Address - Phone:606-634-0758
Mailing Address - Fax:606-785-0879
Practice Address - Street 1:166 A C DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-6318
Practice Address - Country:US
Practice Address - Phone:606-633-2512
Practice Address - Fax:606-785-0879
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02334225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant