Healthcare Provider Details

I. General information

NPI: 1699638734
Provider Name (Legal Business Name): ALLEN MA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15971 STERLING HWY STE A
NINILCHIK AK
99639
US

IV. Provider business mailing address

10470 KATRINA BLVD, NINILCHIK, AK 99639 UNIT 748
NINILCHIK AK
99639
US

V. Phone/Fax

Practice location:
  • Phone: 907-420-0836
  • Fax: 907-420-0837
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number246688
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: