Provider Demographics
NPI:1417478447
Name:ALLEN, PHYLLIS L (HAIR RESTORATION SPE)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:HAIR RESTORATION SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5759 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5258
Mailing Address - Country:US
Mailing Address - Phone:407-733-0705
Mailing Address - Fax:407-521-1595
Practice Address - Street 1:5759 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5258
Practice Address - Country:US
Practice Address - Phone:407-733-0705
Practice Address - Fax:407-521-1595
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL02274701744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management