Provider Demographics
NPI:1710017306
Name:ALTON PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:ALTON PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:NASH
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:618-462-1133
Mailing Address - Street 1:1719 CLAWSON ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-4702
Mailing Address - Country:US
Mailing Address - Phone:618-462-1133
Mailing Address - Fax:618-462-3736
Practice Address - Street 1:1719 CLAWSON ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4702
Practice Address - Country:US
Practice Address - Phone:618-462-1133
Practice Address - Fax:618-462-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-002898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL682520Medicare PIN