Provider Demographics
NPI:1023110590
Name:AT HOME REHAB ALLIANCE, INC
Entity type:Organization
Organization Name:AT HOME REHAB ALLIANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-222-2615
Mailing Address - Street 1:5201 ARROWSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9600
Mailing Address - Country:US
Mailing Address - Phone:502-222-2615
Mailing Address - Fax:502-222-2617
Practice Address - Street 1:5201 ARROWSHIRE DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9600
Practice Address - Country:US
Practice Address - Phone:502-222-2615
Practice Address - Fax:502-222-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty