Provider Demographics
NPI:1013269232
Name:ALLEN, KELLEIGH (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLEIGH
Middle Name:
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 1:3325 COLTON CT
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1899
Mailing Address - Country:US
Mailing Address - Phone:330-345-1175
Mailing Address - Fax:
Practice Address - Street 1:14976 BURBANK RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:OH
Practice Address - Zip Code:44214-9763
Practice Address - Country:US
Practice Address - Phone:330-624-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-09416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist