Provider Demographics
NPI:1285069005
Name:ALLEN, JIMMIE PAUL (DPT)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:PAUL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GREEN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9738
Mailing Address - Country:US
Mailing Address - Phone:801-589-9290
Mailing Address - Fax:
Practice Address - Street 1:4223 IRIS AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GREEN
Practice Address - State:UT
Practice Address - Zip Code:84050-9738
Practice Address - Country:US
Practice Address - Phone:801-589-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT281326-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist