Provider Demographics
NPI:1710677976
Name:ALLEN, NICHOLAS TODD (PTA)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:TODD
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PRIVATE DRIVE 706
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:OH
Mailing Address - Zip Code:45619-8036
Mailing Address - Country:US
Mailing Address - Phone:304-690-2883
Mailing Address - Fax:
Practice Address - Street 1:1000 ADDINGTON DR
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1836
Practice Address - Country:US
Practice Address - Phone:606-833-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02811225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant