MEDICARE: MRS. JAN MIXSON ALLEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305003533	VA

General Provider Information

NPI Number	:	1316930852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAN MIXSON ALLEN PT

Provider Business Mailing Address
First Line	:	404 TABB LAKES DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-4118
Country	:	US
Telephone Number	:	757-619-7241
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 VICTORY BLVD
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3641
Country	:	US
Telephone Number	:	757-776-0736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	03/17/2018

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