MEDICARE: DESHON W ALLEN LMT

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	225700000X	Massage Therapist	MA99401	FL

General Provider Information

NPI Number	:	1396580775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESHON W ALLEN LMT

Provider Business Mailing Address
First Line	:	14627 GATEWAY POINT CIR APT 15302
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-5168
Country	:	US
Telephone Number	:	347-581-3911
Fax Number	:

Provider Business Practice Location Address
First Line	:	13550 VILLAGE PARK DR STE 205
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32837-7833
Country	:	US
Telephone Number	:	407-863-6930
Fax Number	:

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

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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Directions to “ DESHON W ALLEN LMT” Practice Location

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