Provider Demographics
NPI:1285733089
Name:ALLEN, JEFFERY DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:DAVID
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:321 PETTIBONE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1220
Mailing Address - Country:US
Mailing Address - Phone:248-437-2322
Mailing Address - Fax:248-437-2433
Practice Address - Street 1:321 PETTIBONE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1220
Practice Address - Country:US
Practice Address - Phone:248-437-2322
Practice Address - Fax:248-437-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501005549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION93430Medicare ID - Type Unspecified