Provider Demographics
NPI:1891176103
Name:MARK ALLEN PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARK ALLEN PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:714-340-3035
Mailing Address - Street 1:20515 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE D10
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7109
Mailing Address - Country:US
Mailing Address - Phone:714-340-3035
Mailing Address - Fax:714-340-3139
Practice Address - Street 1:20515 YORBA LINDA BLVD
Practice Address - Street 2:SUITE D10
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7109
Practice Address - Country:US
Practice Address - Phone:714-340-3035
Practice Address - Fax:714-340-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMP22591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty