=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558617449
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIANCE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2012
-----------------------------------------------------
Last Update Date | 08/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11520 N CENTRAL EXPY SUITE # 150
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-6605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-680-3669
-----------------------------------------------------
Fax | 866-509-4499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11520 N CENTRAL EXPY SUITE # 150
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-6605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-680-3669
-----------------------------------------------------
Fax | 866-509-4499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MEHRSHAD ZAFARNEJAD
-----------------------------------------------------
Credential | OTR, MPT, PT
-----------------------------------------------------
Telephone | 214-680-3669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 672480000
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------