Individual
NATHAN IRA ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2635 CALDWELL BLVD, STE. B, NAMPA, ID 83651-6407
(208) 442-0577
(208) 442-7455
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 2980
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003173360-000
—
ID
01
—
P01106195
RR MEDICARE
ID
01
—
P01106202
RR MEDICARE
ID
Enumeration date
04/11/2012
Last updated
01/23/2013
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