Provider Demographics
NPI:1225528482
Name:ALLEN, KELLI SUE (PT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:SUE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 PRIMACY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0201
Mailing Address - Country:US
Mailing Address - Phone:901-767-8690
Mailing Address - Fax:901-763-1942
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0201
Practice Address - Country:US
Practice Address - Phone:901-767-8690
Practice Address - Fax:901-763-1942
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist