Healthcare Provider Details

I. General information

NPI: 1871655530
Provider Name (Legal Business Name): ALLIANCE THERAPY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 PRAIRIE PKWY SUITE A
WEST FARGO ND
58078-3145
US

IV. Provider business mailing address

1207 PRAIRIE PKWY SUITE A
WEST FARGO ND
58078-3145
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-0062
  • Fax: 701-356-5412
Mailing address:
  • Phone: 701-356-0062
  • Fax: 701-356-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateND

VIII. Authorized Official

Name: MS. SUSAN MARIE LANDA
Title or Position: PARTNER
Credential: OTRL
Phone: 701-356-0062