MEDICARE: BRIONNA ALLEN MS, LAT, ATC

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		SC
2	2255A2300X	Athletic Trainer		NC

General Provider Information

NPI Number	:	1639700297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIONNA ALLEN MS, LAT, ATC

Provider Business Mailing Address
First Line	:	1429 BRYANT ST STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28208-5201
Country	:	US
Telephone Number	:	704-919-0867
Fax Number	:	704-817-8579

Provider Business Practice Location Address
First Line	:	2816 WORLDREACH DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29707-6571
Country	:	US
Telephone Number	:	803-548-0132
Fax Number	:

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

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	06/16/2026

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