Provider Demographics
NPI:1023496494
Name:ALLIANCE REHAB STL
Entity type:Organization
Organization Name:ALLIANCE REHAB STL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-413-5820
Mailing Address - Street 1:28100 TORCH PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3938
Mailing Address - Country:US
Mailing Address - Phone:630-413-5930
Mailing Address - Fax:630-413-5845
Practice Address - Street 1:723 S LACLEDE STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4911
Practice Address - Country:US
Practice Address - Phone:630-413-5820
Practice Address - Fax:630-413-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLC0041807OtherSTATE LICENSE NUMBER