Provider Demographics
NPI:1831169689
Name:ALLEN, PHILIP (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 FIRESTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-4308
Mailing Address - Country:US
Mailing Address - Phone:302-245-4792
Mailing Address - Fax:
Practice Address - Street 1:2230 FIRESTONE WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-4308
Practice Address - Country:US
Practice Address - Phone:302-245-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP01317258OtherRAILROAD MEDICARE
NJS78342Medicare UPIN
PA199994Medicare ID - Type UnspecifiedPHYSICAL THERAPY
DEP01317258OtherRAILROAD MEDICARE