Provider Demographics
NPI:1922368869
Name:ALLEN, NICHOLAS T (DPT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:T
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:8627 CINNAMON CREEK DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1480
Mailing Address - Country:US
Mailing Address - Phone:210-695-8731
Mailing Address - Fax:210-598-0432
Practice Address - Street 1:3456 HWY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:830-796-3447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04424225100000X
MO2012024837225100000X
TX1260518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist