Provider Demographics
NPI:1396580775
Name:ALLEN, DESHON W (LMT)
Entity type:Individual
Prefix:
First Name:DESHON
Middle Name:W
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14627 GATEWAY POINT CIR APT 15302
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5168
Mailing Address - Country:US
Mailing Address - Phone:347-581-3911
Mailing Address - Fax:
Practice Address - Street 1:13550 VILLAGE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7833
Practice Address - Country:US
Practice Address - Phone:407-863-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA99401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist