Provider Demographics
NPI:1841381639
Name:ALLEN, STEVAN (MA PT)
Entity Type:Individual
Prefix:MR
First Name:STEVAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MA PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:705 OAK GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4319
Mailing Address - Country:US
Mailing Address - Phone:650-363-5674
Mailing Address - Fax:650-363-5675
Practice Address - Street 1:1860 EL CAMINO REAL STE 201
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3111
Practice Address - Country:US
Practice Address - Phone:650-259-8009
Practice Address - Fax:650-259-9769
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06873ZMedicare PIN
CA00PT98780Medicare PIN
CACX525ZMedicare PIN