Healthcare Provider Details

I. General information

NPI: 1124643424
Provider Name (Legal Business Name): ALLIANCE REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 MECHANICSVILLE TPKE STE A
MECHANICSVILLE VA
23111-4579
US

IV. Provider business mailing address

PO BOX 744113
ATLANTA GA
30384-4113
US

V. Phone/Fax

Practice location:
  • Phone: 804-789-8829
  • Fax: 804-789-8873
Mailing address:
  • Phone: 703-239-2300
  • Fax: 703-239-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TODD SIGMON
Title or Position: DIRECTOR OF MEDICARE
Credential:
Phone: 410-970-8190