MEDICARE: KEVIN D 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

General Provider Information

NPI Number	:	1750914941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN D ALLEN DPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 W HAPPY VALLEY RD STE 170
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-2898
Country	:	US
Telephone Number	:	623-322-0654
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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