Provider Demographics
NPI:1164709960
Name:DETTMER, ALICIA B (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:B
Last Name:DETTMER
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-288-6338
Practice Address - Fax:804-285-3237
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2020-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305207205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist