Provider Demographics
NPI:1104157940
Name:ALLIANCE PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ALLIANCE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-240-0512
Mailing Address - Street 1:6131 SHALLOWFORD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7807
Mailing Address - Country:US
Mailing Address - Phone:423-648-7647
Mailing Address - Fax:423-648-7648
Practice Address - Street 1:7625 HAMILTON PARK DR STE 24
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1188
Practice Address - Country:US
Practice Address - Phone:423-648-7647
Practice Address - Fax:423-648-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
1517399Medicare UPIN