Provider Demographics
NPI:1225104342
Name:ALLAN, KENNA RAE (PTA)
Entity Type:Individual
Prefix:MS
First Name:KENNA
Middle Name:RAE
Last Name:ALLAN
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 1:1653 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190
Mailing Address - Country:US
Mailing Address - Phone:615-563-9200
Mailing Address - Fax:
Practice Address - Street 1:420 NORTH UNIVERSITY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-893-2619
Practice Address - Fax:615-893-6035
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA1987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant