Provider Demographics
NPI:1699913384
Name:ALLEN, WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 S. GRAND CANYON DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7173
Mailing Address - Country:US
Mailing Address - Phone:702-448-6042
Mailing Address - Fax:702-430-8970
Practice Address - Street 1:4215 S. GRAND CANYON DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7173
Practice Address - Country:US
Practice Address - Phone:702-448-6042
Practice Address - Fax:702-430-8970
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1368OtherNEVADA LICENSE