Provider Demographics
NPI:1164951141
Name:ALPHA PHYSICAL THERAPY & REHAB LLC
Entity Type:Organization
Organization Name:ALPHA PHYSICAL THERAPY & REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARAK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-400-0063
Mailing Address - Street 1:PO BOX 71821
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-0821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2127 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4835
Practice Address - Country:US
Practice Address - Phone:313-400-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)