Provider Demographics
NPI:1821321522
Name:ALLEN, JUSTINE
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 NE 78TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-9666
Mailing Address - Country:US
Mailing Address - Phone:360-573-4806
Mailing Address - Fax:
Practice Address - Street 1:1503 NE 78TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9666
Practice Address - Country:US
Practice Address - Phone:360-573-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60059251172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist