Provider Demographics
NPI:1831790955
Name:BORN, ALLIE L (LMT)
Entity type:Individual
Prefix:MRS
First Name:ALLIE
Middle Name:L
Last Name:BORN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:L
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:101 E COOPER ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IL
Mailing Address - Zip Code:61728-9248
Mailing Address - Country:US
Mailing Address - Phone:309-261-4515
Mailing Address - Fax:
Practice Address - Street 1:105 S CENTER ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IL
Practice Address - Zip Code:61728-8954
Practice Address - Country:US
Practice Address - Phone:309-261-4515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227020243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist