Healthcare Provider Details

I. General information

NPI: 1760856488
Provider Name (Legal Business Name): STEPHANIE W ALLEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OSPT SOUTH OFFICE 4470 REGENCY PLACE SUITE #100
WHITE PLAINS MD
20695
US

IV. Provider business mailing address

OSPT SOUTH OFFICE 4470 REGENCY PLACE SUITE #100
WHITE PLAINS MD
20695
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-0498
  • Fax:
Mailing address:
  • Phone: 301-934-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25756
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: