Provider Demographics
NPI:1356762868
Name:ALPHA BELMONT LLC
Entity type:Organization
Organization Name:ALPHA BELMONT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA, PHD
Authorized Official - Phone:202-739-1380
Mailing Address - Street 1:1107 BELLE VIEW BLVD APT B1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1107 BELLE VIEW BLVD APT B1
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22307-6629
Practice Address - Country:US
Practice Address - Phone:202-739-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty