Provider Demographics
NPI:1689692485
Name:FRANKLIN, DAVID ALLEN (MSPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:5 BROADWAY PLZ
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1052
Practice Address - Country:US
Practice Address - Phone:765-327-2111
Practice Address - Fax:765-327-2319
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70014840225100000X
IN05003621A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSIN2764001Medicare PIN
IN145210BMedicare PIN