MEDICARE: ALLEN PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501005549	MI

General Provider Information

NPI Number	:	1265602817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	321 PETTIBONE ST
Second Line	:	SUITE 104
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-6000
Country	:	US
Telephone Number	:	248-437-2322
Fax Number	:	248-437-2433

Provider Business Practice Location Address
First Line	:	321 PETTIBONE ST
Second Line	:	SUITE 104
City	:	SOUTH LYON
State	:	MI
Zip	:	48178-6000
Country	:	US
Telephone Number	:	248-437-2322
Fax Number	:	248-437-2433

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFERY D ALLEN
Credential	:	P.T.
Telephone Number	:	248-437-2322

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	03/10/2008

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Directions to “ALLEN PHYSICAL THERAPY ” Practice Location

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