Provider Demographics
NPI:1942689088
Name:ALLEN, JOSHUA DAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 IDAHO ST STE A
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1258
Mailing Address - Country:US
Mailing Address - Phone:208-934-9011
Mailing Address - Fax:208-934-9014
Practice Address - Street 1:423 IDAHO ST STE A
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1258
Practice Address - Country:US
Practice Address - Phone:208-934-9011
Practice Address - Fax:208-934-9014
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist