Provider Demographics
NPI:1003363623
Name:ALLIANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:QUIN
Authorized Official - Last Name:SIRMON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:601-596-7948
Mailing Address - Street 1:22 E DONNINGTON CT
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6612
Mailing Address - Country:US
Mailing Address - Phone:601-596-7948
Mailing Address - Fax:
Practice Address - Street 1:2310 COMMONS COURT
Practice Address - Street 2:UNIT 2, BOX 8
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270
Practice Address - Country:US
Practice Address - Phone:601-596-7948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy