Provider Demographics
NPI:1972621431
Name:APPALACHIAN REHAB CENTERS, INC.
Entity type:Organization
Organization Name:APPALACHIAN REHAB CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALELI
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAMYAITHONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:304-583-8808
Mailing Address - Street 1:1455 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2129
Mailing Address - Country:US
Mailing Address - Phone:770-642-6100
Mailing Address - Fax:678-367-4603
Practice Address - Street 1:125C MAIN ST
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1211
Practice Address - Country:US
Practice Address - Phone:304-583-8808
Practice Address - Fax:304-583-8809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERY PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-26
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0202827000Medicaid
WV001723824OtherMT STATE BCBS
WV001723824OtherMT STATE BCBS