Individual
DANIELLE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 LEGACY PLZ W, LA PORTE, IN 46350-5268
(503) 621-6697
Mailing address
211 BRIARWOOD CIR, APT L, LA PORTE, IN 46350-7470
(503) 621-6697
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002442A
IN
Other
Enumeration date
07/17/2015
Last updated
07/17/2015
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