Provider Demographics
NPI:1902182546
Name:ALLIANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SWATI
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:630-922-0050
Mailing Address - Street 1:1879 BAY SCOTT CIR
Mailing Address - Street 2:STE. #105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1108
Mailing Address - Country:US
Mailing Address - Phone:630-922-0050
Mailing Address - Fax:630-922-0574
Practice Address - Street 1:454 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1385
Practice Address - Country:US
Practice Address - Phone:630-759-4411
Practice Address - Fax:630-759-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL148786904001Medicaid
IL148786904001Medicaid
ILP00126091Medicare PIN