Provider Demographics
NPI:1578977757
Name:ALPHA BELMONT LLC
Entity Type:Organization
Organization Name:ALPHA BELMONT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-739-1380
Mailing Address - Street 1:6205 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2970
Mailing Address - Country:US
Mailing Address - Phone:202-739-1380
Mailing Address - Fax:
Practice Address - Street 1:6205 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2970
Practice Address - Country:US
Practice Address - Phone:202-739-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty