Provider Demographics
NPI:1265602817
Name:ALLEN PHYSICAL THERAPY
Entity type:Organization
Organization Name:ALLEN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-437-2322
Mailing Address - Street 1:321 PETTIBONE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-6000
Mailing Address - Country:US
Mailing Address - Phone:248-437-2322
Mailing Address - Fax:248-437-2433
Practice Address - Street 1:321 PETTIBONE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-6000
Practice Address - Country:US
Practice Address - Phone:248-437-2322
Practice Address - Fax:248-437-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N93430Medicare PIN