Provider Demographics
NPI:1255338919
Name:SLIGHT, ALLEN L (PT)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:L
Last Name:SLIGHT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1634
Mailing Address - Country:US
Mailing Address - Phone:765-362-6740
Mailing Address - Fax:765-362-6750
Practice Address - Street 1:402 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1634
Practice Address - Country:US
Practice Address - Phone:765-362-6740
Practice Address - Fax:765-362-6750
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006085A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05006085AOtherPHYSICAL THERAPIST LICENS
IN000000333863OtherANTHEM BLUE CROSS #
IN05006085AOtherPHYSICAL THERAPIST LICENS