Provider Demographics
NPI:1518188374
Name:ALLEN, CHARLYN RAE (PT CLT-LANA)
Entity Type:Individual
Prefix:
First Name:CHARLYN
Middle Name:RAE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT CLT-LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 CATTLERIDGE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6014
Mailing Address - Country:US
Mailing Address - Phone:941-951-0706
Mailing Address - Fax:941-552-1429
Practice Address - Street 1:6050 CATTLERIDGE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6014
Practice Address - Country:US
Practice Address - Phone:941-951-0706
Practice Address - Fax:941-552-1429
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 11208225100000X
NC9251225100000X
NJ40QA00616300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist