Healthcare Provider Details

I. General information

NPI: 1104661230
Provider Name (Legal Business Name): ALI ECE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 HENRY ST
BEACON NY
12508-2305
US

IV. Provider business mailing address

211 HENRY ST
BEACON NY
12508-2305
US

V. Phone/Fax

Practice location:
  • Phone: 916-806-6587
  • Fax:
Mailing address:
  • Phone: 916-806-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: