MEDICARE: CALEB ALLEN DPT

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	P16926	NC
2	225100000X	Physical Therapist	294862	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	954902003	OTHER	MN	MEDICA CHOICE/UNITED HEALTHCARE CHOICE

General Provider Information

NPI Number	:	1629573712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB ALLEN DPT

Provider Business Mailing Address
First Line	:	210 S MAIN ST
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-3221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE STE 212
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3815
Country	:	US
Telephone Number	:	951-534-0600
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	01/26/2026

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