Healthcare Provider Details

I. General information

NPI: 1780070920
Provider Name (Legal Business Name): LYNNETTE ALLISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 S MAJOR DR
BEAUMONT TX
77707-5019
US

IV. Provider business mailing address

106 WHIPPERWILL LN
BEDFORD PA
15522-7024
US

V. Phone/Fax

Practice location:
  • Phone: 409-861-4611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE010375
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2108840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: