Provider Demographics
NPI:1588754857
Name:ALPHA HOME PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ALPHA HOME PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:317-888-4033
Mailing Address - Street 1:8130 S MERIDIAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4986
Mailing Address - Country:US
Mailing Address - Phone:317-888-4033
Mailing Address - Fax:317-888-4018
Practice Address - Street 1:8130 S MERIDIAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4986
Practice Address - Country:US
Practice Address - Phone:317-888-4033
Practice Address - Fax:317-888-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
157585Medicare PIN
IN157585Medicare Oscar/Certification