Provider Demographics
NPI:1972398865
Name:ALLEN, CAROLINE THADDA (LMT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:THADDA
Last Name:ALLEN
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4639 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-8981
Mailing Address - Country:US
Mailing Address - Phone:608-449-0738
Mailing Address - Fax:
Practice Address - Street 1:1642 PLAINFIELD AVE STE 106
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0282
Practice Address - Country:US
Practice Address - Phone:608-449-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13123-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist