Basic Information
| Provider Information | |||||||||
| NPI: | 1407933039 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 COMMERCIAL WAY | ||||||||
| Address2: | |||||||||
| City: | FALLON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894062600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758673904 | ||||||||
| FaxNumber: | 7758673901 | ||||||||
| Practice Location | |||||||||
| Address1: | 52 COMMERCIAL WAY | ||||||||
| Address2: | |||||||||
| City: | FALLON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894062600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758673904 | ||||||||
| FaxNumber: | 7758673901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2043 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.