Provider Demographics
NPI:1962606681
Name:ALLAN, CARRIE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:ALLAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 SAN LORENZO RD
Mailing Address - Street 2:
Mailing Address - City:PALMS SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264
Mailing Address - Country:US
Mailing Address - Phone:760-327-4647
Mailing Address - Fax:
Practice Address - Street 1:7540 NORTH 19TH AVENUE
Practice Address - Street 2:SYNERTX
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:760-327-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000PT36225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000PT360Medicare ID - Type Unspecified