Provider Demographics
NPI:1114222593
Name:FRANK, ALICIA SHANNON (LPTA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:SHANNON
Last Name:FRANK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:SHANNON
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1201
Mailing Address - Country:US
Mailing Address - Phone:334-208-1131
Mailing Address - Fax:
Practice Address - Street 1:1301 MESA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-3905
Practice Address - Country:US
Practice Address - Phone:334-208-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5563225200000X
TX2079810225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant