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General NPI Number Information
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NPI Number | 1336592278
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Entity Type | Organization
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Legal Business Name | ALLENS WELLNESS
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/15/2016
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Provider Practice Location Address
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Address Line | 6010 SANDY SPRINGS CIR
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City | ATLANTA
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State | GA
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Zip | 30328-3871
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Country | US
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Telephone | 770-905-0415
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Fax |
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Provider Business Mailing Address
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Address Line | 4310 GLENRIDGE STRATFORD DR
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City | ATLANTA
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State | GA
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Zip | 30342-4928
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Country | US
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Telephone | 770-905-0415
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | MR. JOSHUA JEROME ALLEN
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Credential | LMT, NMT, PT
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Telephone | 770-905-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT006522
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License Number State | GA
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