Provider Demographics
NPI:1144413642
Name:KAVALASKIA, ALICE VICTORIA (PT)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:VICTORIA
Last Name:KAVALASKIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ALICE
Other - Middle Name:VICTORIA
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:82 MORGAN ST #2
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715
Mailing Address - Country:US
Mailing Address - Phone:828-606-0703
Mailing Address - Fax:828-665-2101
Practice Address - Street 1:82 MORGAN ST #2
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715
Practice Address - Country:US
Practice Address - Phone:828-606-0703
Practice Address - Fax:828-665-2101
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8204225100000X
TN7649225100000X
WA8019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist