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General NPI Number Information
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NPI Number | 1760099824
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Entity Type | Individual
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Provider Name | JEROME ALLEN JR. PERSONAL TRAINER
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Gender | Male
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 7324 SOUTHWEST FWY STE 325
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City | HOUSTON
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State | TX
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Zip | 77074-2058
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Country | US
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Telephone | 832-930-2970
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Fax |
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Provider Business Mailing Address
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Address Line | 6520 BROADWAY ST APT 322
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City | PEARLAND
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State | TX
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Zip | 77581-7720
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Country | US
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Telephone | 228-229-0156
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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 | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | 1170068411
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License Number State |
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