Provider Demographics
NPI:1275848087
Name:ALLEN, SHAMEL SPINKS (MPT)
Entity Type:Individual
Prefix:MRS
First Name:SHAMEL
Middle Name:SPINKS
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 OLD GOVERNOR PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4570
Mailing Address - Country:US
Mailing Address - Phone:636-724-0696
Mailing Address - Fax:
Practice Address - Street 1:34 OLD GOVERNOR PL
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4570
Practice Address - Country:US
Practice Address - Phone:636-724-0696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002023149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist