Provider Demographics
NPI:1740235654
Name:ALLEN, KATHRYN (MPT)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3001
Mailing Address - Country:US
Mailing Address - Phone:310-418-8586
Mailing Address - Fax:
Practice Address - Street 1:11022 SANTA MONICA BLVD STE 430
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7533
Practice Address - Country:US
Practice Address - Phone:310-470-1480
Practice Address - Fax:310-470-1478
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist