Provider Demographics
NPI:1336724053
Name:ALLEN, DAVID MORRISON
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MORRISON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 HEWITT ST APT 14H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2041
Mailing Address - Country:US
Mailing Address - Phone:919-525-6673
Mailing Address - Fax:
Practice Address - Street 1:4203 HEWITT ST APT 14H
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2041
Practice Address - Country:US
Practice Address - Phone:919-525-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000032783019222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist