Provider Demographics
NPI:1225134646
Name:ALLEN, MARNIE ELIZABETH (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MARNIE
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:MARNIE
Other - Middle Name:ELIZABETH
Other - Last Name:CARAMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:149 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5813
Mailing Address - Country:US
Mailing Address - Phone:207-873-4638
Mailing Address - Fax:207-873-1541
Practice Address - Street 1:149 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5813
Practice Address - Country:US
Practice Address - Phone:207-873-4638
Practice Address - Fax:207-873-1541
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432159399Medicaid