MEDICARE: MRS. KARA EMILY ALLEN PTA

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	225200000X	Physical Therapy Assistant	20622	FL

General Provider Information

NPI Number	:	1679685846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARA EMILY ALLEN PTA

Provider Business Mailing Address
First Line	:	1721 ANNISTON RD
Second Line	:	322
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-8543
Country	:	US
Telephone Number	:	304-553-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	10790 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1078
Country	:	US
Telephone Number	:	904-260-0800
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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