Provider Demographics
NPI:1861566341
Name:ALLIS, ROBERT ARMSTRONG (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARMSTRONG
Last Name:ALLIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2638
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93448-2638
Mailing Address - Country:US
Mailing Address - Phone:805-473-7499
Mailing Address - Fax:805-473-7494
Practice Address - Street 1:271 FIVE CITIES DR
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3009
Practice Address - Country:US
Practice Address - Phone:805-473-7499
Practice Address - Fax:805-473-7494
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 14762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14762OtherBLUE CROSS PIN
183834100OtherUS DEPT OF LABOR
CAOPT147620OtherBLUE SHIELD PIN
CAPT14762OtherCAL-CARE PIN
CAPT14762OtherCAL-CARE PIN
183834100OtherUS DEPT OF LABOR