Provider Demographics
NPI:1407146343
Name:ALLY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ALLY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIDYA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-525-3000
Mailing Address - Street 1:32858 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3048
Mailing Address - Country:US
Mailing Address - Phone:734-525-3000
Mailing Address - Fax:734-525-3001
Practice Address - Street 1:32858 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3048
Practice Address - Country:US
Practice Address - Phone:734-525-3000
Practice Address - Fax:734-525-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012274225100000X
MI5201005036225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty