Provider Demographics
NPI:1780648857
Name:ALAMEDA FITNESS & REHAB
Entity Type:Organization
Organization Name:ALAMEDA FITNESS & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:361-814-4800
Mailing Address - Street 1:5017 SARATOGA BLVD STE 139
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2841
Mailing Address - Country:US
Mailing Address - Phone:361-814-4800
Mailing Address - Fax:361-814-4830
Practice Address - Street 1:5017 SARATOGA BLVD STE 139
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2841
Practice Address - Country:US
Practice Address - Phone:361-814-4800
Practice Address - Fax:361-814-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549630000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0055JNOtherBCBS