Basic Information
| Provider Information | |||||||||
| NPI: | 1962465328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 E SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476701758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128877733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 702 OLD WHEATLAND RD | ||||||||
| Address2: | |||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475913620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128821141 | ||||||||
| FaxNumber: | 8128866333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 36000768A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.