MEDICARE: KRISTIN KAY ALLEN

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	2251G0304X	Geriatric Physical Therapist	103314	MO

General Provider Information

NPI Number	:	1265705917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN KAY ALLEN

Provider Business Mailing Address
First Line	:	406 FORBY ESTATES DR
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-2379
Country	:	US
Telephone Number	:	636-549-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	738 W PORT PLZ
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3010
Country	:	US
Telephone Number	:	314-677-7554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2012
Last Update Date	:	02/10/2012

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