Provider Demographics
NPI:1093098907
Name:CASE, ALICIA MAE (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MAE
Last Name:CASE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:406-535-2919
Mailing Address - Fax:406-535-2920
Practice Address - Street 1:613 NE MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2081
Practice Address - Country:US
Practice Address - Phone:406-535-2919
Practice Address - Fax:406-535-2920
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-17324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTL-11341OtherSTATE LICENSE