1861566341 NPI number — ROBERT ARMSTRONG ALLIS P.T.

Table of content: ROBERT ARMSTRONG ALLIS P.T. (NPI 1861566341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861566341 NPI number — ROBERT ARMSTRONG ALLIS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLIS
Provider First Name:
ROBERT
Provider Middle Name:
ARMSTRONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861566341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PISMO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93448-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-473-7499
Provider Business Mailing Address Fax Number:
805-473-7494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
271 FIVE CITIES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PISMO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93449-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-473-7499
Provider Business Practice Location Address Fax Number:
805-473-7494
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 14762 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT14762 . This is a "BLUE CROSS PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 183834100 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: OPT147620 . This is a "BLUE SHIELD PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PT14762 . This is a "CAL-CARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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