Provider Demographics
NPI:1336293513
Name:ALLEN, VICKI WHITMORE (PT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:WHITMORE
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 1:5423 JACKS CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3705
Mailing Address - Country:US
Mailing Address - Phone:410-747-2715
Mailing Address - Fax:410-747-8062
Practice Address - Street 1:5423 JACKS CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3705
Practice Address - Country:US
Practice Address - Phone:410-747-2715
Practice Address - Fax:410-747-8062
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT5812225100000X
MD22147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist