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General NPI Number Information
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NPI Number | 1891176103
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Entity Type | Organization
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Legal Business Name | MARK ALLEN PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 04/21/2016
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Provider Practice Location Address
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Address Line | 20515 YORBA LINDA BLVD SUITE D10
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City | YORBA LINDA
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State | CA
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Zip | 92886-7109
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Country | US
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Telephone | 714-340-3035
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Fax | 714-340-3139
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Provider Business Mailing Address
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Address Line | 20515 YORBA LINDA BLVD SUITE D10
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City | YORBA LINDA
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State | CA
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Zip | 92886-7109
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Country | US
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Telephone | 714-340-3035
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Fax | 714-340-3139
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK B ALLEN
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Credential | MPT
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Telephone | 714-340-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | MP22591
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License Number State | CA
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