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General NPI Number Information
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NPI Number | 1720125123
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Entity Type | Individual
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Provider Name | JAMES PATRICK ALLEN PT, OMPT
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20952 E 12 MILE RD SUITE 110
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3200
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Country | US
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Telephone | 586-498-3500
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Fax | 586-498-3510
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Provider Business Mailing Address
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Address Line | 44460 HIGHGATE DR
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1489
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Country | US
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Telephone | 586-286-3746
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Fax | 586-286-3325
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | L962644
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License Number State | MI
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