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Individual

ALENA COUSINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1303 W 1ST ST, SPRINGFIELD, OH 45504-1920
(937) 717-4045
(937) 717-4811
Mailing address
1303 W 1ST ST, SPRINGFIELD, OH 45504-1920
(937) 717-4045
(937) 717-4811

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3254
AR
225100000X
Physical Therapist
Primary
PT 016062
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
H2090800
MEDICAID GROUP
OH
Enumeration date
08/25/2015
Last updated
09/02/2015
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