Basic Information
| Provider Information | |||||||||
| NPI: | 1043262850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA REHABILITATION, LLC | ||||||||
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| OtherOrganizationName: | ALPHA REHABILITATION, PLLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 290 NICKEL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800202183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034609151 | ||||||||
| FaxNumber: | 3034607443 | ||||||||
| Practice Location | |||||||||
| Address1: | 290 NICKEL ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800202183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034609151 | ||||||||
| FaxNumber: | 3034607443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | STEPAN | ||||||||
| AuthorizedOfficialFirstName: | CURTIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3034475522 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.