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General NPI Number Information
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NPI Number | 1518378595
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Entity Type | Individual
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Provider Name | BRYAN JEFFREY ALLEN L.M.T
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Gender | Male
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 209 BETTY RD
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City | PENSACOLA
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State | FL
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Zip | 32507-2307
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Country | US
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Telephone | 850-293-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 209 BETTY RD
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City | PENSACOLA
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State | FL
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Zip | 32507-2307
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Country | US
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Telephone | 850-293-3000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA74015
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 100094054
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License Number State | FL
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