Provider Demographics
NPI:1588863062
Name:ALLEN, DANIEL LEWIS
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEWIS
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:1707 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2770
Practice Address - Country:US
Practice Address - Phone:302-479-0880
Practice Address - Fax:302-479-0550
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017627225100000X
DEJ1-0001996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102302845-0001Medicaid
306058OtherUNISON
DEP00885356OtherRAILROAD MEDICARE
DE1588863062Medicaid
PA30067515OtherKEYSTONE MERCY
DE37446240000OtherIBC
DE156356ZB82Medicare PIN
PA115168VLZMedicare PIN