Healthcare Provider Details

I. General information

NPI: 1023496494
Provider Name (Legal Business Name): ALLIANCE REHAB STL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 S LACLEDE STATION RD
SAINT LOUIS MO
63119-4911
US

IV. Provider business mailing address

28100 TORCH PKWY SUITE 600
WARRENVILLE IL
60555-3938
US

V. Phone/Fax

Practice location:
  • Phone: 630-413-5820
  • Fax: 630-413-5845
Mailing address:
  • Phone: 630-413-5930
  • Fax: 630-413-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN CALLEN
Title or Position: PRESIDENT
Credential:
Phone: 630-413-5820