Provider Demographics
NPI:1083037063
Name:ILONCAI, ALICE LORRAINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:LORRAINE
Last Name:ILONCAI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1376 HUNT RD.
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48744-9744
Mailing Address - Country:US
Mailing Address - Phone:989-670-9414
Mailing Address - Fax:
Practice Address - Street 1:1376 HUNT RD
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744-9744
Practice Address - Country:US
Practice Address - Phone:989-670-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502001889225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant