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General NPI Number Information
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NPI Number | 1740578251
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Entity Type | Organization
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Legal Business Name | ALLEGIANT REHAB
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 753 MAIN STREET STREET STE C
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City | ALAMO
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State | TX
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Zip | 78516
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Country | US
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Telephone | 313-559-5535
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Fax |
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Provider Business Mailing Address
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Address Line | 753 MAIN STREET STREET STE C
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City | ALAMO
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State | TX
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Zip | 78516
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Country | US
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Telephone | 313-559-5535
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Fax |
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Authorized Official
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Title or Position | CERTIFIED OCCUPATIONAL THERAPY ASST
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Name | DER JUANA SHARMEN THOMPSON
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Credential | COTA
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Telephone | 313-559-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 5202007235
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 210898
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License Number State | TX
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