Provider Demographics
NPI:1295565661
Name:ALLEN, JONATHON (LMT)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 DAMON ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-9116
Mailing Address - Country:US
Mailing Address - Phone:815-505-4763
Mailing Address - Fax:
Practice Address - Street 1:16850 COUNTY HIGHWAY X
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6908
Practice Address - Country:US
Practice Address - Phone:715-861-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17586-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist