Healthcare Provider Details

I. General information

NPI: 1982914933
Provider Name (Legal Business Name): DOUGLAS LANE ALLEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 HIGHWAY 58 SUITE 132
CHATTANOOGA TN
37416-1840
US

IV. Provider business mailing address

6711 MOUNTAIN VIEW RD. SUITE 115
OOLTEWAH TN
37363-6667
US

V. Phone/Fax

Practice location:
  • Phone: 423-710-3051
  • Fax: 423-710-3052
Mailing address:
  • Phone: 423-238-1127
  • Fax: 423-238-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000008768
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: