Provider Demographics
NPI:1306066642
Name:PENN, ALLISON HAYES (PTA)
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:HAYES
Last Name:PENN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 NAAMAN FOREST BLVD
Mailing Address - Street 2:#2735
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5679
Mailing Address - Country:US
Mailing Address - Phone:972-414-8801
Mailing Address - Fax:
Practice Address - Street 1:5649 NAAMAN FOREST BLVD
Practice Address - Street 2:APART# 2734
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5679
Practice Address - Country:US
Practice Address - Phone:972-414-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2027084171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor