Provider Demographics
NPI:1215039003
Name:ALLEN, JOHN EDWIN (RKT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWIN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RKT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8669
Mailing Address - Country:US
Mailing Address - Phone:847-356-0819
Mailing Address - Fax:
Practice Address - Street 1:216 OAK KNOLL DR
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8669
Practice Address - Country:US
Practice Address - Phone:847-356-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist