Provider Demographics
NPI:1518378595
Name:ALLEN, BRYAN JEFFREY (LMT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JEFFREY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 BETTY RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-2307
Mailing Address - Country:US
Mailing Address - Phone:850-293-3000
Mailing Address - Fax:
Practice Address - Street 1:209 BETTY RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-2307
Practice Address - Country:US
Practice Address - Phone:850-293-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA74015225700000X
FL1000940543747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist