Provider Demographics
NPI:1043593627
Name:ALLEN, EILEEN MARIE (LPT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARIE
Other - Last Name:AUSEM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:106 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-1716
Mailing Address - Country:US
Mailing Address - Phone:570-265-5695
Mailing Address - Fax:
Practice Address - Street 1:9579 VOCATIONAL DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9043
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012379-1225100000X
PAPT003456L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist