Healthcare Provider Details

I. General information

NPI: 1679735708
Provider Name (Legal Business Name): TERESA SUMMEY ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 SE VILLAGE LOOP
VANCOUVER WA
98683-8103
US

IV. Provider business mailing address

2911 SE VILLAGE LOOP
VANCOUVER WA
98683-8103
US

V. Phone/Fax

Practice location:
  • Phone: 360-433-6346
  • Fax:
Mailing address:
  • Phone: 360-433-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00003320
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: