Provider Demographics
NPI:1508860131
Name:ALLEN, BRITT HALEY (PT)
Entity Type:Individual
Prefix:MR
First Name:BRITT
Middle Name:HALEY
Last Name:ALLEN
Suffix:
Gender:M
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:PO BOX 1688
Mailing Address - Street 2:2703 E MAIN
Mailing Address - City:MADISONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77864-6688
Mailing Address - Country:US
Mailing Address - Phone:936-870-3475
Mailing Address - Fax:936-870-3476
Practice Address - Street 1:2703 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TX
Practice Address - Zip Code:77864-2229
Practice Address - Country:US
Practice Address - Phone:936-348-9916
Practice Address - Fax:936-348-9936
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX058642202Medicaid
TX8A2376Medicare UPIN