1770799041 NPI number — ALLIANCE REHABILITATION, LLC

Table of content: (NPI 1770799041)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770799041 NPI number — ALLIANCE REHABILITATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE REHABILITATION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLIANCE PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770799041
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 744113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-4113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-239-2300
Provider Business Mailing Address Fax Number:
703-239-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 ELDEN ST STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERNDON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20170-4839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-581-8999
Provider Business Practice Location Address Fax Number:
703-481-0396
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SIGMON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF MEDICARE
Authorized Official Telephone Number:
410-970-8190

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K949 . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".




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