Basic Information
| Provider Information | |||||||||
| NPI: | 1124296769 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLAIN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11920 WALTERS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770671956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136962150 | ||||||||
| FaxNumber: | 7136962133 | ||||||||
| Practice Location | |||||||||
| Address1: | 11920 WALTERS RD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770671956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136962150 | ||||||||
| FaxNumber: | 7136962133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2008 | ||||||||
| LastUpdateDate: | 02/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1067007 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 10670 | 01 | TX | PHYSICAL THERAPIST | OTHER |