Provider Demographics
NPI:1043573819
Name:BURRELL-FITCH, ALICIA ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:BURRELL-FITCH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 LIVERPOOL CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6965
Mailing Address - Country:US
Mailing Address - Phone:720-544-7712
Mailing Address - Fax:720-544-7712
Practice Address - Street 1:4313 LIVERPOOL CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6965
Practice Address - Country:US
Practice Address - Phone:720-544-7712
Practice Address - Fax:720-544-7712
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist