Basic Information
| Provider Information | |||||||||
| NPI: | 1922368869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | D.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8627 CINNAMON CREEK DR | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106958731 | ||||||||
| FaxNumber: | 2105980432 | ||||||||
| Practice Location | |||||||||
| Address1: | 3456 HWY 16 SOUTH | ||||||||
| Address2: | |||||||||
| City: | BANDERA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8307963447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2012 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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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 | 11-04424 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2012024837 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1260518 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.