Basic Information
| Provider Information | |||||||||
| NPI: | 1144704420 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | BRYANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 AIRPORT RD TRLR 3 | ||||||||
| Address2: | |||||||||
| City: | REXBURG | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834405032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086805380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 CORPORATE BLVD S | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142946300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2018 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227900000X | 10150401 | OR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | 227900000X | LRT-1548 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered |
No ID Information.