Provider Demographics
NPI:1508146598
Name:ALLEN, CLARISSA IRENE (LMT)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:IRENE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11541 MURCOTT WAY
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-6838
Mailing Address - Country:US
Mailing Address - Phone:813-527-4391
Mailing Address - Fax:
Practice Address - Street 1:11541 MURCOTT WAY
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-6838
Practice Address - Country:US
Practice Address - Phone:813-527-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist