Provider Demographics
NPI:1760099824
Name:ALLEN, JEROME JR (PERSONAL TRAINER)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:ALLEN
Suffix:JR
Gender:M
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 BROADWAY ST APT 322
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7720
Mailing Address - Country:US
Mailing Address - Phone:228-229-0156
Mailing Address - Fax:
Practice Address - Street 1:7324 SOUTHWEST FWY STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2058
Practice Address - Country:US
Practice Address - Phone:832-930-2970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1170068411225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist