Provider Demographics
NPI:1922471796
Name:ALLEN, ERIC LEON (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 BENJULYN RD
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-6973
Mailing Address - Country:US
Mailing Address - Phone:850-764-5007
Mailing Address - Fax:
Practice Address - Street 1:2475 E NINE MILE RD STE K
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7796
Practice Address - Country:US
Practice Address - Phone:850-764-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 79379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist