MEDICARE: SHAWN 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	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1166743	OTHER	TX	LICENSE#

General Provider Information

NPI Number	:	1477688976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN ALLEN

Provider Business Mailing Address
First Line	:	11960 VIENNA APPLE RD
Second Line	:
City	:	KELLER
State	:	TX
Zip	:	76248-7581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 BASSWOOD BLVD STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4476
Country	:	US
Telephone Number	:	817-498-0700
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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Directions to “ SHAWN ALLEN ” Practice Location

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