Provider Demographics
NPI:1215495932
Name:ALLEN, JOSHUA R
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:4383 NE 133RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2650
Mailing Address - Country:US
Mailing Address - Phone:360-449-2232
Mailing Address - Fax:
Practice Address - Street 1:19206 SE 1ST ST STE 118
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7478
Practice Address - Country:US
Practice Address - Phone:360-433-9016
Practice Address - Fax:360-433-9809
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61537498225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist