Provider Demographics
NPI:1295588119
Name:ALLEN, NICOLE RENAE CROUSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENAE CROUSE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENAE
Other - Last Name:CROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:17030 NE 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:WALDO
Mailing Address - State:FL
Mailing Address - Zip Code:32694-4302
Mailing Address - Country:US
Mailing Address - Phone:321-205-8974
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist