Provider Demographics
NPI:1407933039
Name:ALLEN, SUSAN J (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
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 1:52 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2600
Mailing Address - Country:US
Mailing Address - Phone:775-867-3904
Mailing Address - Fax:775-867-3901
Practice Address - Street 1:52 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2600
Practice Address - Country:US
Practice Address - Phone:775-867-3904
Practice Address - Fax:775-867-3901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2043225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist