Provider Demographics
NPI:1841205267
Name:ALLEN, GINGER LEE (PT)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 KUKUI GROVE ST SUITE 3
Mailing Address - Street 2:
Mailing Address - City:LINUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-246-0144
Mailing Address - Fax:808-245-5148
Practice Address - Street 1:4381 KUKUI GROVE ST SUITE 3
Practice Address - Street 2:
Practice Address - City:LINUE
Practice Address - State:HI
Practice Address - Zip Code:96766
Practice Address - Country:US
Practice Address - Phone:808-246-0144
Practice Address - Fax:808-245-5148
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52928203Medicaid
HI52928203Medicaid