Provider Demographics
NPI:1962140053
Name:ALLEN, DANIEL R (LMT MA89580)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMT MA89580
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:REX
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:495 NE 4TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-4542
Mailing Address - Country:US
Mailing Address - Phone:954-613-1001
Mailing Address - Fax:
Practice Address - Street 1:495 NE 4TH ST STE 3
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-4542
Practice Address - Country:US
Practice Address - Phone:954-613-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89580225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist