Provider Demographics
NPI:1649216144
Name:ALLIANCE PHYSICAL THERAPY GROUP LLC
Entity Type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY GROUP LLC
Other - Org Name:ARMOR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-356-5000
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:601 MICHIGAN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-355-4284
Practice Address - Fax:616-355-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30046OtherBCBS FACILITY CODE
MI30814OtherBCBS FACILITY NUMBER
MI1649216144OtherNPI
MI0P04810Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER
MI236850Medicare Oscar/Certification