Provider Demographics
NPI:1326214701
Name:ALLIANCE REHABILITATION, INC
Entity Type:Organization
Organization Name:ALLIANCE REHABILITATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPT
Authorized Official - Phone:662-397-8416
Mailing Address - Street 1:109 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-2628
Mailing Address - Country:US
Mailing Address - Phone:662-397-8416
Mailing Address - Fax:662-509-9935
Practice Address - Street 1:109 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-2628
Practice Address - Country:US
Practice Address - Phone:662-397-8416
Practice Address - Fax:662-509-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT 1493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07705342Medicaid
MS1619033453OtherINDIVIDUAL NPI
MS1619033453OtherINDIVIDUAL NPI
MS512I650039Medicare UPIN