Healthcare Provider Details

I. General information

NPI: 1790005221
Provider Name (Legal Business Name): LIANNE EATON ALLEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 LINDEN PONDS WAY HOBART GROVE
HINGHAM MA
02043-8714
US

IV. Provider business mailing address

205 LINDEN PONDS WAY HOBART GROVE
HINGHAM MA
02043-8714
US

V. Phone/Fax

Practice location:
  • Phone: 781-534-7168
  • Fax: 781-534-7382
Mailing address:
  • Phone: 781-534-7168
  • Fax: 781-534-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number9072
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: