1881719623 NPI number — MRS. LANA KAY ALLEN P.T.

Table of content: MRS. LANA KAY ALLEN P.T. (NPI 1881719623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881719623 NPI number — MRS. LANA KAY ALLEN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
LANA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
LANA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1881719623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1361 TALL TIMBERS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILMER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75645-8366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-736-4939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 EAST HAWKINS PARKWAY
Provider Second Line Business Practice Location Address:
PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-544-6930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

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:  1105500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 1105500 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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