Provider Demographics
NPI:1659316818
Name:ALLEN, BRAD HEATH (PT MS)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:HEATH
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PT MS
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Mailing Address - Street 1:2918 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
Mailing Address - Country:US
Mailing Address - Phone:501-279-9255
Mailing Address - Fax:501-279-9257
Practice Address - Street 1:2918 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-279-9255
Practice Address - Fax:501-279-9257
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPT2036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5W937Medicare ID - Type Unspecified