Provider Demographics
NPI:1497785216
Name:PHYSICAL THERAPY ALLIANCE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ALLIANCE, LLC
Other - Org Name:STAR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:A/R DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DILWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-591-6590
Mailing Address - Street 1:PO BOX 682446
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-2446
Mailing Address - Country:US
Mailing Address - Phone:615-591-6590
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:6610 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-3045
Practice Address - Country:US
Practice Address - Phone:502-762-1243
Practice Address - Fax:502-762-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY071770Medicare Oscar/Certification