Basic Information
| Provider Information | |||||||||
| NPI: | 1285790618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | DOUGLAS | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327516317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074267066 | ||||||||
| FaxNumber: | 4074260556 | ||||||||
| Practice Location | |||||||||
| Address1: | 4501 VINELAND RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328117375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074267066 | ||||||||
| FaxNumber: | 4074260556 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225100000X | PT 19440 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.