Provider Demographics
NPI:1205139540
Name:ALLEN, KRISTIN MICHELLE (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 CHAMPAGNE LN
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-6319
Mailing Address - Country:US
Mailing Address - Phone:805-235-2263
Mailing Address - Fax:
Practice Address - Street 1:6125 CHAMPAGNE LN
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-6319
Practice Address - Country:US
Practice Address - Phone:805-235-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist