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General NPI Number Information
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NPI Number | 1922471796
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Entity Type | Individual
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Provider Name | ERIC LEON ALLEN LMT
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Gender | Male
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 11/03/2015
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Provider Practice Location Address
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Address Line | 2475 E NINE MILE RD STE K
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City | PENSACOLA
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State | FL
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Zip | 32514-7796
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Country | US
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Telephone | 850-764-5007
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Fax |
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Provider Business Mailing Address
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Address Line | 547 BENJULYN RD
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City | CANTONMENT
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State | FL
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Zip | 32533-6973
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Country | US
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Telephone | 850-764-5007
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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 | MA 79379
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License Number State | FL
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