Provider Demographics
NPI:1700081239
Name:ALLIANCE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:307-382-3228
Mailing Address - Street 1:1977 DEWAR DR
Mailing Address - Street 2:STE J
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5737
Mailing Address - Country:US
Mailing Address - Phone:307-382-3228
Mailing Address - Fax:307-382-6886
Practice Address - Street 1:1977 DEWAR DR
Practice Address - Street 2:J
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5737
Practice Address - Country:US
Practice Address - Phone:307-382-3228
Practice Address - Fax:307-382-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty