Provider Demographics
NPI:1043457088
Name:ALLIANCE REHABILITATION, LLC
Entity Type:Organization
Organization Name:ALLIANCE REHABILITATION, LLC
Other - Org Name:ALLIANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIKANTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-239-2300
Mailing Address - Street 1:PO BOX 1822
Mailing Address - Street 2:
Mailing Address - City:MERRIFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22116-8022
Mailing Address - Country:US
Mailing Address - Phone:703-239-2300
Mailing Address - Fax:703-239-2301
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:STE 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3154
Practice Address - Country:US
Practice Address - Phone:703-704-5771
Practice Address - Fax:703-704-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK949OtherCAREFIRST