Provider Demographics
NPI:1619572724
Name:ALLEN, RENEE MARIE (LMT, MS, MA)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT, MS, MA
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7047 CHANNEL RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9623
Mailing Address - Country:US
Mailing Address - Phone:231-330-5657
Mailing Address - Fax:
Practice Address - Street 1:7047 CHANNEL RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9623
Practice Address - Country:US
Practice Address - Phone:231-330-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MI224Y00000X
MI7501006016225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501006016OtherMASSAGE THERAPY LICENSE