Provider Demographics
NPI:1598536229
Name:ALLEN, TREMELL DEON JR
Entity Type:Individual
Prefix:MR
First Name:TREMELL
Middle Name:DEON
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 W ROCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1203
Mailing Address - Country:US
Mailing Address - Phone:318-313-8738
Mailing Address - Fax:
Practice Address - Street 1:155 N STADIUM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-4026
Practice Address - Country:US
Practice Address - Phone:479-575-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer