Provider Demographics
NPI:1134603541
Name:ALLEN, CHRISTINA ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 N HITE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3275
Mailing Address - Country:US
Mailing Address - Phone:606-226-6464
Mailing Address - Fax:
Practice Address - Street 1:1906 GOLDSMITH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2066
Practice Address - Country:US
Practice Address - Phone:502-636-3207
Practice Address - Fax:502-636-0024
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty