Provider Demographics
NPI:1407450042
Name:ALLEN, JASON DAMONE (LMT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DAMONE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 ARBORETUM DR APT 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-2380
Mailing Address - Country:US
Mailing Address - Phone:336-818-9031
Mailing Address - Fax:
Practice Address - Street 1:7820 ARBORETUM DR APT 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-2380
Practice Address - Country:US
Practice Address - Phone:336-818-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18143225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty