MEDICARE: WILLIAM 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	1361	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1368	OTHER	NV	NEVADA LICENSE

General Provider Information

NPI Number	:	1699913384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ALLEN PT

Provider Business Mailing Address
First Line	:	4215 S. GRAND CANYON DR.
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7173
Country	:	US
Telephone Number	:	702-448-6042
Fax Number	:	702-430-8970

Provider Business Practice Location Address
First Line	:	4215 S. GRAND CANYON DR.
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7173
Country	:	US
Telephone Number	:	702-448-6042
Fax Number	:	702-430-8970

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

Provider Enumeration Date	:	02/03/2009
Last Update Date	:	03/30/2017

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Directions to “ WILLIAM ALLEN PT” Practice Location

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