Provider Demographics
NPI:1558577056
Name:ALLEN, CARRIE LEIGH (MPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEIGH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 OLIVIA LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63967-8259
Mailing Address - Country:US
Mailing Address - Phone:573-429-2853
Mailing Address - Fax:
Practice Address - Street 1:1206 GORDON DUCKWORTH DR
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1911
Practice Address - Country:US
Practice Address - Phone:870-598-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist