Provider Demographics
NPI:1710687314
Name:ALLMON, MIA SAMANTHA (LRT/CTRS)
Entity Type:Individual
Prefix:MISS
First Name:MIA
Middle Name:SAMANTHA
Last Name:ALLMON
Suffix:
Gender:F
Credentials:LRT/CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 S REVERE CV APT 304
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8692
Mailing Address - Country:US
Mailing Address - Phone:828-331-7701
Mailing Address - Fax:
Practice Address - Street 1:504 KINTYRE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4111
Practice Address - Country:US
Practice Address - Phone:704-927-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4399225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist