Provider Demographics
NPI:1356452502
Name:ALLEN, WILLIAM B (RPT,ATC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N PINE ST STE A
Mailing Address - Street 2:PO BOX 1539
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-4743
Mailing Address - Country:US
Mailing Address - Phone:620-231-5855
Mailing Address - Fax:620-231-5906
Practice Address - Street 1:1623 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2656
Practice Address - Country:US
Practice Address - Phone:620-223-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140952OtherBCBS
KS462987Medicaid
KS140952OtherBCBS
KS140952Medicare PIN